Point of care Intestinal Ultrasound: Lauren Westafer
Point of care Intestinal Ultrasound: Lauren Westafer
When looking into someone’s abdomen, the first thing you'll notice is that it almost looks like there is nothing there. For Dr. Lauren Westafer, the gut looks like a black box. There's a lot of gas which makes it hard to see arteries and organs. In this podcast, Lauren discusses point of care Intestinal Ultrasound. To do an intestinal ultrasound, first, rub the curvilinear probe over the abdomen... That's it as far as technique is concerned! There is nothing overly complicated for such a useful procedure. Why do we still need an ultrasound for small bowel obstructions when we already have other tools like patient history, a physical exam, and x-ray? Unfortunately, these tools are all unreliable for diagnosing small bowel obstructions. What's more, the training for gut ultrasound doesn't take much time. It takes around 10 minutes to do 5-10 scans. The scanning procedure itself takes less than five minutes to perform. For such a high-value procedure, it takes an incredibly low amount of effort and time! When conducting a gut ultrasound, you are looking for dilated bowel (greater than 2.5 cm) and abnormal peristalsis. Lauren explains exactly what to look for, especially when recognising patterns of abnormal peristalsis. Lauren encourages us to embrace a gut ultrasound. From DAS SMACC, tune in to a discussion on Point of Care Intestinal Ultrasound by Lauren Westafer. For more like this, head to our podcast page. #CodaPodcast
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Point of care Intestinal Ultrasound: Lauren Westafer
- 1. LAUREN WESTAFER, DO, MPH CAUTION: CONTAINS GAS Photo:Douglas Porter Unpacking the Black Box of Gut Ultrasound
- 2. Photo:Craig Sunter
- 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. History Physical exam Diagnosis of SBO Unreliable for X-ray
- 5. CT SCAN = TIME
- 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. Scanning Time < 5 minutes
- 8. “Mow the lawn” Assess paracolic gutters, quadrants
- 9. Dilated Bowel Abnormal Peristalsis
- 10. Dilated Bowel > 2.5 CM
- 11. Abnormal Peristalsis
- 12. Photo: Josh Semans Piano key sign Plicae circulares
- 13. Normal SBO
- 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. 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. 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. 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. Ileus vs SBO Transition Point Cause Caution:
- 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. ? SBO
- 21. SBO
- 22. Ileus + edema
- 23. Ascites + Tumor
- 24. Free Air
- 25. SMALL BOWEL OBSTRUCTION ULTRASOUND Dilated bowel >2.5 cm Abnormal peristalsis
- 26. +
- 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. Photo: Josh Semans Piano key sign Plicae circulares Dilated bowel > 2.5 cm