Re: Protocols for ER Pelvics
From: DuBose, Terry (DuboseTerryJ@exchange.uams.edu)
Tue Aug 25 11:26:10 1998
Donna, Victoria, et al. I agree in principle, but not in absolutes. The
point I would draw the line is with those who may say that endovaginal is
ALL that is EVER needed. I can't forget a case we were referred after
having an exam in a lab where they only did EV for GYN and early OB. They
had called fluid in the uterine cavum a 4 week IUP. The physician didn't
buy it and sent her to us for a 2nd. Transabdominally I found an 8 week
abdominal fetus with a beating heart well above the uterine fundus... out of
the field of view of the EV.
I think if you can document a normal IUP by EV, that may be all that is
needed. But we also need to be flexible, very case is not the same.
--
Peace, Terry J. DuBose, M.S., RDMS
I agree with Donna K.
I have a strong bias toward doing transvaginal sonography. I believe
that my bias may
come from working in an OB/GYN office setting for several years.
Whenever we have
a patient with a possible spontaneous abortion, ectopic pregnancy or
with acute pelvic
pain...the FIRST thing we do is a transvaginal sonogram. It takes
such a short time to
verify a viable first trimester IUP with transvaginal sonography.
I've never understood
why I was required to have a patinet fill via Foley when I could
usually answer the
diagnostic question with a quick, realtively painless transvaginal
exam.
To my mind, for first trimester pregnancies and acute pelvic pain in
an ER setting,
transvaginal scanning should be the first thing done. Then, if more
information is
needed...a transabdominal scan could be performed with bladder
distension via Foley.
I have actually stood between an obstetrician and radiologist on an
ER call with a
patient on the table who had a positive HCG, acute pain and
bleeding.
The radiologist was insisting on a Foley and transabdominal scan.
The OB said "WHY? Just
do a transvaginal scan." In the end, the radiologist said that
he/she was reading the
exam...and they wanted the Foley and transab. scan. I did the
transvag. first with the
OB...viable IUP. Then, we had to cath the poor lady and take
transab. images for the
radiologist. WHY?
It seems to me that the most cost effective, efficient and patient
friendly thing we can
do is use the transvaginal scan as a first scan.
What do ya'll think?
Donna Kepple wrote:
>
> Hold on! it is 1998!!! Transvaginal sonography IS pelvic
sonography. I think
> this argument should have been over years age. We routinely take a
look
> transabdominally only for masses that extend out of the focal zone
of the
> transducer. You don't have to have the bladder full for this at
all. The PELVIC
> sonogram is then done TRANSVAGINALLY.
>
> ______________________________ Reply Separator
> Subject: Re: [Fwd: Protocols for ER Pelvics]
> ______________________________ Reply Separator
> Author: buddy@redrose.net (JT or JL Tomko) at +INET
> Date: 8/23/98 5:13 PM
>
> >
> >Hello All,
> > I need to know policies from those of you who have an ER and
> >perform pelvics and first trimester pregnancies. In an effort to
reduce
> >nosocomial infections and pt. discomfort, my ER has started
refusing to
> >cathetrize and electing to oral fill instead. While I can
understand the
> >motives, when a sonographer is being called out to perform a
study I
> >personally feel that we should not have to wait while the patient
fills
> >by mouth. Doesn't this method defeat the "emergency" nature of
the
> >procedure? Also, these patients have probably already had an "in
and
> >out" cath for a U/A. Most of the other hospitals in town have
standing
> >orders for catheterization. What do you do? I need to know either
way.
> >Thanks for your help. Rene' Davis RDMS,RVT
>
> Rene',
>
> Our institution will place a foley catheter for ALL emergency
examinations.
> When the ER doesn't want to do so the argument/discussion is
raised to the
> emergency of the procedure. Our Rads argue if the patient is P.O.
> hydradtion the surgeons will have our heads with anesthesia not
too far
> behind! If the patient is not a potential for surgery the case is
not an
> emergency. Occasionally we have a patient refuse the foley and
the
> examination is scheduled for a specific time as the patient fills
via the IV
> route or chooses to come back the next morning with a full
bladder.
>
> Good luck on this issue.
>
> Janet
