Robert Jones, DO Profile picture
Jan 12, 2022 8 tweets 10 min read Read on X
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
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. Image
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

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More from @RJonesSonoEM

Feb 3, 2021
Known distal UVJ stone. Has new rt flank pain. Mild hydro but what else? #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #MedTwitter @ACEP_EUS @SeeWithSound @PhilipsPOCUS @IMPOCUSFocus @medpedshosp @NephroP @jminardi21 @HeyDrNik @TomJelic @cianmcdermott @MH_EMultrasound @thepocusatlas
Area of increased echogenicity of parenchyma seen in upper pole. @Manoj_Wickram @tomkehrl @MH_EMultrasound @MetroHealth_EM @Casscln @ria_dancel @cm_lopresti @DRsonosRD
Also has trace perinephric fluid seen (arrow)
Read 17 tweets
Jun 3, 2020
Differentiating portal venous gas from pneumobilia on ultrasound. See thread. #POCUS #FOAMus #FOAMed #IMPOCUS #MedEd #MedTwitter #ultrasound @ACEP_EUS @USIGcleveland @MetroHealth_EM @aedrake65
Case 1. Liver TRV sweep. Which is present? Answer poll.
Case 1. Which is present?
Read 9 tweets
May 19, 2020
Pt-Bilat LE pain/swelling 5 days.Prior hx of unprovoked DVT/PE years ago but off meds due to insurance. See thread. POCUS DVT #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #FOAMcc @ACEP_EUS @medpedshosp @cianmcdermott @jminardi21 @grepmeded @siddharth_dugar @msiuba @NephroP @SonoStache
What POCUS DVT protocol to use? 2-point or 3-point or extended? With or without Doppler? Meta-analysis showed good performance of 2 and 3 point POCUS but need to understand POCUS compression limitations if only compression used: pubmed.ncbi.nlm.nih.gov/31145304/?from…
Adhikari and colleague article showed 6.3% false neg rate due to prox isolated DVT with 2-point compression. Limitations of POCUS prox compression DVT exam go beyond just missing isolated/focal DVT. pubmed.ncbi.nlm.nih.gov/25465473/
Read 9 tweets
May 12, 2020
Patient with RUQ abdominal pain. Difficulty finding GB. Pt denies history of prior abdominal surgery and no scars seen. See thread. #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #MedStudentTwitter @medpedshosp @NephroP @grepmeded @cianmcdermott @ACEP_EUS @PhilipsPOCUS
GB Sag and TRV sweeps. GB not seen. No surgical clips seen. Contracted GB, agenesis of GB, ectopic location of GB, prior removal (and patient forgot--it does happen)?
On Sag image, don't confuse bowel contents with GB filled with sludge
Read 6 tweets
Mar 24, 2020
Short image tweetorial on thoracic ultrasound findings in pneumonia. #POCUS #IMPOCUS #FOAMed #FOAMus #Medtwitter #Meded #COVID19 @medpedshosp @cianmcdermott @msiuba @siddharth_dugar @grepmeded @NephroP @emresidents
Normal lung ultrasound. A-profile with thin pleural line with lung sliding. Linear transducer used.
Irregular pleural line with patchy B-lines. Seen in viral (including COVID19) and bacterial pneumonia. This patient had mycoplasma pneumonia. Linear probe used.
Read 11 tweets

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