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Hardcore EM: Gut Ultrasound: The Next Frontier

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Hardcore EM: Gut Ultrasound: The Next Frontier by Lauren Westafer

Published in: Health & Medicine
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Hardcore EM: Gut Ultrasound: The Next Frontier

  1. 1. LAUREN WESTAFER, DO, MPH CAUTION: CONTAINS GAS Photo:Douglas Porter Unpacking the Black Box of Gut Ultrasound
  2. 2. Photo:Craig Sunter
  3. 3. Small Bowel Obstruction Ultrasound Dilated bowel >2.5 cm Abnormal peristalsis Assess for: Rub the curvilinear probe over the abdomen Photo:Craig Sunter Unpacking the Black Box of Gut Ultrasound:
  4. 4. History Physical exam Diagnosis of SBO Unreliable for X-ray
  5. 5. CT SCAN = TIME
  6. 6. Training 10 minutes 5-10 scans Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011 Aug;28(8):676-8
  7. 7. Scanning Time < 5 minutes
  8. 8. “Mow the lawn” Assess paracolic gutters, quadrants
  9. 9. Dilated Bowel Abnormal Peristalsis
  10. 10. Dilated Bowel > 2.5 CM
  11. 11. Abnormal Peristalsis
  12. 12. Photo: Josh Semans Piano key sign Plicae circulares
  13. 13. Normal SBO
  14. 14. +LR 9.55 -LR 0.04 Taylor MR, Lalani N.Adult small bowel obstruction.Acad Emerg Med. 2013;20(6):528–44. doi:10.1111/acem.12150.
  15. 15. US X-RAY +LR 1.55 -LR 0.59 +LR 9.55 -LR 0.04 Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011;28(8):676–8. doi:10.1136/emj.2010.095729.
  16. 16. SENSITIVITY 0 0.2 0.4 0.6 0.8 1.0 CT POCUS XRAY Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):528–44. doi:10.1111/ acem.12150.
  17. 17. X-RAY 27 (36%) US 0 (0%) Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011;28(8):676–8. doi:10.1136/emj.2010.095729. Katz DS, Baker ME, Rosen MP, Lalani T, Carucci LR, Cash BD, Kim DH, Piorkowski RJ, Small WC, Smith MP, Yaghmai V, Yee J, Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® suspected small-bowel obstruction. [online publication]. Reston (VA): American College of Radiology (ACR); 2013. Hedging
  18. 18. Ileus vs SBO Transition Point Cause Caution:
  19. 19. I NEED THE CT SCAN Maung AA, Johnson DC, Piper GL et al. Evaluation and Management of Small-Bowel Obstruction. J Trauma. 73(5):S362-S369, November 2012
  20. 20. ? SBO
  21. 21. SBO
  22. 22. Ileus + edema
  23. 23. Ascites + Tumor
  24. 24. Free Air
  25. 25. SMALL BOWEL OBSTRUCTION ULTRASOUND Dilated bowel >2.5 cm Abnormal peristalsis
  26. 26. +
  27. 27. References: 1. Carpenter CR, Pines JM. The end of X-rays for suspected small bowel obstruction? Using evidence-based diagnostics to inform best practices in emergency medicine. Acad. Emerg. Med. 2013;20(6):618–20. 2. Vicario SJ, Price TG. "Bowel Obstruction and Volvulus." Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. pp 581-583. 3. Torrey SP, Henneman PL. "Disorders of the Small Intestine." Rosen's Emergency Medicine. pp 1184-86. 4. Taylor MR, Lalani N. Adult small bowel obstruction. Acad. Emerg. Med. 2013;20(6):528–44. 5. Böhner H, Yang Q, Franke C, Verreet PR, Ohmann C. Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur. J. Surg. 1998;164(10):777–84. 6. Maung AA, Johnson DC, Piper GL et al. Evaluation and Management of Small-Bowel Obstruction. J Trauma. 73(5):S362-S369, November 2012 7. Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J. 2011 Aug;28(8):676-8. 8. Guttman J, Stone MB, Kimberly HH, Rempell JS. Point-of-care ultrasonography for the diagnosis of small bowel obstruction in the emergency department.CJEM. 2014 Aug 1;16(0):30-3.
  28. 28. Photo: Josh Semans Piano key sign Plicae circulares Dilated bowel > 2.5 cm

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