Monday, May 2, 2016

US for SBO

emDocs - October 30, 2014 - By Alerhand S - Edited by Koyfman A
"ED Pearls
  • CT is more expensive, confers radiation, not available 24 hrs/day everywhere, takes longer (oral contrast, CT availability), can be dangerous to transport patient away from physicians/nurses
  • US is cheaper, no radiation, performed quickly at bedside, allows frequent re-exams, no transport from clinical area
  • Can reduce need for plain abdominal films
  • Can expedite surgical consultation/treatment (NG tube, pain meds, transfer to Surg floor) prior to CT scan
  • Can improve ED flow
  • Consider replacing abdominal x-ray with bedside US
POCUS to Evaluate for SBO
  • Select highest frequency possible based on body habitus
  • 3-5 MHz in large adults
  • Probe marker towards patient’s R side
  • Sequential graded compression in transverse plane, from RLQ to LUQ
  • Then from LLQ to RUQ in longitudinal plane
  • Gentle downward pressure applied every few cm to assess bowel compressibility
  • Look for dilated (>25 mm), non-compressible small bowel proximal to collapsed, compressible bowel
  • Secondary signs: localized bowel wall edema (>3 mm thick), free fluid within abdomen, no change during peristalsis
  • To identify transition point, follow abnormal bowel until you see normal bowel
  • Lack of compressibility (on its own w/o transition point) cannot differentiate between obstruction and ileus"