- Written by Jakub Bartnik
A 30 year old female presents to the emergency department with right lower abdominal pain. No vaginal bleeding.
Her vitals are: HR 101 BP 115/70 RR20 O2 100%. Upreg: positive
As she seems to be quite uncomfortable, you decide to perform a bedside ultrasound.
Having learned that free fluid in the right upper quadrant predicts the need for operative intervention in a suspected ectopic pregnancy, you start with a curvilinear probe in the RUQ:
With a positive urine pregnancy test and free fluid in Morrison’s pouch, you call ObGyn STAT to the bedside, order pre-op labs, start 2 large bore IVs, and type and cross 2 units of blood in preparation for possible clinical deterioration.
While waiting for OB, you decide to ultrasound the right adnexa and uterus trans-abdominally.
Note the complex free fluid in the pelvis and right adnexa, as well as the empty uterus.
OB comes down within minutes, looks at your bedside ultrasound and takes the patient to the OR for immediate intervention.
While waiting for a radiology-based ultrasound, this patient very well may have had a worse outcome.
POCUS saves the day!
Two studies to review for this critical application of POCUS:
Take home point: even if you are not comfortable with pelvic bedside ultrasounds in pregnant females, you can still save a life if you are competent at the FAST exam.