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"
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