Severe Abd pain, n/v, & distention. BP 96/50, HR 124. No bowel sounds. Diffuse tenderness. WBC 17.9. Lactate 3.8. POCUS shown. #POCUS #FOAMed #FOAMus #FOAMcc #MedEd #EMBound @ACEP_EUS @PhilipsPOCUS @MetroHealth_EM @MH_EMultrasound @NephroP @jminardi21 @kyliebaker888 @TomJelic
Diagnosis? @TaotePOCUS @Manoj_Wickram @medpedshosp @msiuba @siddharth_dugar @vanessapho @tessanelson32 @Paul_Dreher_ @jilshim @aedrake65 @SpencerSeballos @thepocusatlas @POCUSaurusRex @SmallsSono @drjgutt @medcramUS @cianmcdermott @ThinkingCC @khaycock2 @IM_Crit_ @IMPOCUSFocus
Dx: Complicated SBO. Meets SBO criteria with diameter > 2.5 cm greater than 10 cm in length. Also has absence of peristalsis and adjacent free fluid--concerning for complicated SBO
NG tube placed. Just under 2.5 liters returned. Taken to the OR. Had ischemic segment of bowel just proximal to the obstruction.
While this patient didn't have the classic to and fro movement of bowel contents, here is another patient with to and fro movement noted.
Here is a rare cause of obstruction. This patient has a GS ileus.
Here is a systematic review and meta-analysis. Shows Bowel POCUS Sensitivity 92.4% and Specificity 96.6%. pubmed.ncbi.nlm.nih.gov/28797559/ @MGottliebMD
Keeping in mind that POCUS is operator dependent, this study showed that POCUS is moderately sensitive (but less specific) when in the hands of a diverse group of EM physicians. Better in hands of fellowship trained. pubmed.ncbi.nlm.nih.gov/30762916/ @tomkehrl @Takeokun @jchristianfox
Share this Scrolly Tale with your friends.
A Scrolly Tale is a new way to read Twitter threads with a more visually immersive experience.
Discover more beautiful Scrolly Tales like this.