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I had an interesting case of
perforated appendicitis a few weeks ago that I wanted to share
images from with you. So this was
a 14-year-old boy who had one week
of increasing abdominal pain, and actually had two
hospital based ultrasounds in that time
which had failed to find any pathology and were marked on a normal
appendix.
So I have to admit I didn't think that me
bringing the point of care ultrasound machine into his room would have that much value
but I did so at the start of my exam and could tell very quickly after putting
the probe on
more from this idea of 'probe palpation'
as how the patient reacts to using the probe.
They often will react differently than when you just use your fingers
because sometimes they're distracted by the screen
and I feel like it gets rid of some of their bias in terms of reacting
painfully when maybe their stimulus for pain isn't that great
with your fingers. So I could tell this guy was definitely in pain and
immediately on the screen
I knew he had serious pathology this wasn't five minutes spent scanning for the
appendix
this was you put the probe on and you see this...
What's in this video is just dilated loops of bowel everywhere
with no directional peristalsis. This is the kind of thing you see
in advanced helios or a fairly long standing small bowel obstruction.
So given his history, his sonographically aided
examination and the images I felt pretty confident right away that he was going
to be a perforated appendicitis
and that allowed me to do something different in his care
I didn't think that there was much point in trying to send him for
a diagnostic imaging ultrasound where they would have the same difficulties I
would in trying to see through all these dialated loops to find or not find the
appendix
and putting the whole picture together I felt pretty confident that the risk to
benefit of getting him a CT
weighed heavily on the side of his benefit. And the CT
confirmed that he had perforated appendicitis, which I was able to get a
result from much faster
than if I hadn't been using point of care ultrasound and expedited his care
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