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The emotional and visceral pain of a good POCUS call

May 11, 2014

Dr. Sean Ryan works in a rural hospital with no surgical coverage and in this case there was no access to ultrasound because it was a Saturday morning.   As you know people aren’t supposed to have emergencies in rural communities on weekends requiring ultrasound.

A 24 year old woman presents with RLQ pain and Dr. Ryan applies his POCUS to the patient.  He does this because ED docs feel that emergencies can happen 24/7 in flagrant disregard of the laws of radiology.  Mostly he did it because he was all pumped up after taking the EDE2 course.  (Even though appendix scans are part of EDE3…hey whatever gets you motivated!)

This is what he found:



Just under the abdominal wall muscle you can see the classic blind-ended tube with echo lucent layers of edema.  You can follow the stalk back to the cecum nicely, reinforcing that indeed the appendix is being visualized.

The best part of this story is that it helped him convince a surgeon at another hospital to take the patient when he emailed the images to him.

Actually let me correct the last statement:  The best part of the story really is the surgeon’s message after taking the patient to the O.R.

“As much visceral and emotional pain as this is going to cause me, I have to say that you were right.  She had appendicitis.”

Besides a patient’s heartfelt thanks, isn’t that about the best reward an emergency physician can ask for?

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