Nobody expects the liver abscess

I reviewed the computer charting, elderly lady with one day history of fever, vomiting, diarrhea and confusion. Sounded like a boring old gastro, give her fluids, take cultures and refer. No need to drag the U/S to the room when I’m already behind and pressed for time. Still, spare the probe and spoil the patient. I thought I could at least check her IVC and CVS to gauge fluid status. Immediately this great big liver abscess popped up (and maybe was locally tender-seemed like it). I changed my management, ordered Tazosyn, and asked the Radiologist to drain the abscess. There were PMN’s and the same E. coli that grew in the blood. I think the time has come that POCUS is part of the regular physical exam.