Thread by @PulmCrit

POCusing the RUQ!
Themes of the presentation (and life in general)
- certainty stifles science
- look at US with soft eyes
- @kyliebaker888 at #HRreloaded

diagnostic pardigm depends on pre-test probability!
starting out with accurate pre-test probility essential
- @kyliebaker888 at #HRreloaded

one series of ED patients with RUQ pain: 1/3 of patients with cholecystitis. thus, most patients with RUQ pain will have some other pathology - don't anchor too soon!
- @kyliebaker888 at #HRreloaded

Kylie sorted her POCUS scans for RUQ scan retrospectively. about 1/3 had acute biliary pathology, but 10% had a non-biliary severe diagnosis!
- @kyliebaker888 at #HRreloaded

best to start with a broad differential diagnosis (a.k.a. broad priors).
- @kyliebaker888 at #HRreloaded

Start by looking at the great vessles..
- @kyliebaker888 at #HRreloaded

then look at the pancreas
- @kyliebaker888 at #HRreloaded

then pan through the left liver lobe
- ductal dilation?
- free air due to portal vein gas?
- @kyliebaker888 at #HRreloaded

then take a look at the heart.
If the heart is failing, that could cause some edema of the gallbladder. Thus, early evaluation of the heart could affect your pre-test probability
- @kyliebaker888 at #HRreloaded

Then look at the right lung base
don't forget to look for thoracic pathology which could cause RUQ pain
- @kyliebaker888 at #HRreloaded

then look at kidney.
Only after looking at ALL other organs, then look at the gallbladder. This prevents tunnel vision from focusing on the binary question of chole / no chole.
- @kyliebaker888 at #HRreloaded

and finally, take a look at the common bile duct
- @kyliebaker888 at #HRreloaded