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Lloyd’s Corner: POCUS makes things so easy, even the patient’s spouse can make the diagnosis!

March 18, 2019 0 Comments

Here is another case from Dr Lloyd Gordon of Humber in Toronto…

A 32 year-old man presented to the ED with vague and occasional symptoms of urinary discomfort and mild hematuria for 4 months. He had been given multiple courses of antibiotics. The history was otherwise unremarkable. Physical exam was completely negative. The patient looked fine. What to do?

Plan A: Urinary testing and another course of antibiotics and referral back to the walk-in clinic and the same GPs.

Plan B: POCUS

Let’s go with Plan B.

The wife immediately said: “That shouldn’t be there!

It took about 10 seconds for the wife to make the proper diagnosis. This would likely have been visible on POCUS at the start of symptoms.

[Editor’s note: Should this change your practice for UTIs? Should we EDE all bladders in all UTI cases at the first visit? No, the yield would be too low. But you should consider doing so when a UTI is not responding to treatment. Definitely something I will do on a go-forward! Good on Lloyd for picking this up]

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