1/52 worsening abdominal pain, subjective distension, several small loose stools today. Passing flatus. No vomiting.
Appendicectomy, cholecystectomy, hysterectomy (converted to laparotomy at the time, so large midline incision).
- HR 100
- BP 110/74
- RR 20
- O2 Sat 99%
- T 36.2C
- Generally tender abdomen to palpation, not peritonitic
POCUS was performed (images by Z Robinson) with acquisition method gained by running the probe over the abdomen in a lawnmower pattern and the 2 most useful images provided:
The second clip shows back and forth (or to and fro) peristalsis.
The patient had a high-grade small bowel obstruction on subsequent CT requiring surgical management.
The CT that was going to diagnose the obstruction and provide more detail on where and why it came to be has to be ordered anyway right?
The beauty of having POCUS in your armamentarium allows you to increase the pre-test probability of the CT as well as early inpatient referral and other patient flow processes.
Zac is an ED registrar at RHH with an interest in POCUS (Currently using a first generation Butterfly iQ)