Re: GYN:Suggestions please
From: James S Smeltzer MD (gaperina@mindspring.com)
Mon Aug 31 06:30:04 1998
Ask the patient to replace and scan in Sim's position. LLD with legs
pulled up from behind. JSS
At 07:30 AM 8/30/1998 -0500, you wrote:
>It is interesting to me that one office where I scan has the oldest
>sonography equipment and the most modern table so I can trendelenberg at
>that place. However, where I have the best equipment also is the most
>primitive table!!! Go figure that one.
>Anyway, I have had great success in the patients with two manuvers. On
>one, we bring the legs up over the chest as much as possible while
>scanning vaginally. For the other, have the patient get on all fours on
>the table and scan from behind. This can also be accomplished with the
>patient standing beside the table and bending over, particularly in the
>massive obese patient.
>
>There are a few problems with these techniques. You absolutely must
>have a very co=operative and understanding patient who is interested in
>hepling you obtain the best possible view. Many women will not want to
>place themselves in what some may consider a humiliating position. It
>is best to have help with these manuvers. Some women are willing in the
>spirit but unable to do this physically. I prefer to have the doctor
>present to view as I scan so that there is no question about obtaining
>correct images, This is not a procedure that you want to repeat.
>
>If you can try these, you will be surprised at how helpful they are.
>
>At Fri, 28 Aug 1998, yani wrote:
>>
>>At Tue, 14 Apr 1998, J.Tomko wrote:
>>>The trendelenberg position would be of tremendous help definitely. But,
since you don't have access to such a table, then I would suggest applying
extra pressure and angling from the side.
>>>I have been seeing many more post-menopausal women lately and am
>>>frustrated with scanning technique when the patient presents with
>>>uterine decensus (and retroverted position.) It seems I cannot
>>>adequately image the detail of the uterus and ovaries with
>>>transabdominal approach and the angle is too perpendicular to the u/s
>>>beam to get a true long axis and coronal view of the uterus with vaginal
>>>views. I tried gently reducing the decensus with the vaginal probe but
>>>cannot move the uterus high enough in the pelvis to work this out. The
>>>pessary of course hinders ultrasound impossible. I do not have a table
>>>to trendelenberg the patient. ~~Any~~ suggestions or technique tips are
>>>welcomed.
>>>
>>>Thanks,
>>>
>>>Janet
>>>
>>>--
>>>Does a Roman EMT call an IV a '4'?
>>>
>
>--
>Scot
>
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