QUESTION:
USN is short for ultrasound. ".....If a pt comes in with exposure hx, pain and has cervical motion tenderness, I've always presumptively treated and haven't done USN unless the pt was sick enough to be inpatient. What role does the USN play? Is it to pick up abscesses?"
REPLY:
The bi-manual pelvic exam has outlived its usefulness. Major impact findings of transvaginal ultrasound include ovarian cysts, free fluid in cul de sac, fibroids, missed AB's, post Cesarean hematoma(muy painful), one dermoid cyst per year, and the occasional ruptured appendix. Yesterday we confirmed a Mullerian agenesis case at age 20. She had seen two Gyn's and failed menses induction by Provera.
The clinical context of Medicos' ultrasound-by-the-physician at the bedside follows. Medicos is a bilingual English /Spanish health care system seeing uninsured and medicaid patients. It is open 7 days a week and sees slightly more than 700 patients each week in Memphis. Nashville is separate. Medicos is open access with appointments if desired. Medicos-Memphis saw 37,000 visits and delivered 422 babies last year. Our Cesarean rate is about 22%. We dismiss an additional 125 pregnant women every year. Medicos performs 4 200 ultrasounds annually(10-15 a day), and 25% are gyn/pelvic ultrasound examinnations.
When necessary physicians have the authority to provide charity care, and a third of our ultrasound examinations are gratis.
The major take home message is the synergy of family medicine ultrasound versus the fragmentation of OB-radiology. Most family medicine physicians are trained to believe that an ultrasound examination involves looking at static images and/or reading a report. Nothing could be further from the truth. The examination is a dynamic and tactile 5-10 minutes which involves a simultaneous conversation between the woman and her physician. It usually involves sexual counseling and family planning. It is high tech and high touch.
They sent me home from the ER with Lortabs but my pelvic pain is all over my stomach now. Why?
I have fluid in Morison's pouch because my appendicitis perforated.
My Gyn won't see me until next week, and the pain is terrible. One dark space is the bladder and the other dark space is not. Is this important?
Significant free fluid with intestinal loops floating in the left side of the fluid. Ruptured ovarian cyst vs severe PID.
With best wishes for your professional success,
Wm. MacMillan Rodney MD, FAAFP, FACEP
Private Practice; Clinical Professor and Chair
Medicos para la Familia
Procedural Skills and Office Technology
www.psot.com
www.medicosmundial.com
Index--ultrasound gyn, pelivc pain, yield of ultrasound
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Posted by: maypedana | January 09, 2012 at 01:08 AM