Re: Protocols for ER Pelvics
From: June Standley and William Neubert (june_Bill@email.msn.com)
Tue Aug 25 13:28:08 1998
I agree with Terry. Also, remember the poor sonographer in all this. For
example, it's 2:30 AM and we get called in to do a case, EV only, then find
out we have to do a full bladder scan, too. The patient has to go back to
the ER for the foley insertion, and we have to WAIT. By the time we crawl
home, it's looking like 4:00 AM ...... IF the ER hasn't added on another
case "since we were already there" ... and IF we don't get called back again
before our 8 AM shift begins. We try to take everyone into consideration.
Our radiologists do whatever the ER doc wants and are NEVER rigid in
requiring a foley and full bladder if they feel the EV exam is adequate.
However, we always start on the premise that a foley will be inserted before
we get there and that both techniques will be used unless the ER doc, the
patient, or the radiologist says otherwise. June
-----Original Message-----
From: DuBose, Terry <DuboseTerryJ@exchange.uams.edu>
To: Multiple recipients of list <ultrasound@talk.obgyn.net>
Date: Tuesday, August 25, 1998 9:27 AM
Subject: Re: Protocols for ER Pelvics
>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
>_________________________________
> > ______________________________ Reply Separator
> > Subject: Re: [Fwd: Protocols for ER Pelvics]
> > 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
>
|
|
