My new instrument in the last 2 years has been the
ultrasound probe. It adds tremendous
value to my physical exam. Residents in our program have traditionally been
learning ultrasound skills as part of examining the patient: especially in the
ICU. Lungs look wet, kidneys look ok,
bladder is full and IVC is plump.. We have now gotten
information that can really make the care of the patient really swift. Official
ultrasounds are still obtained but a quick and important organ examination can
save lives and critical time..
Besides, I now feel that as nephrologists, this might be an
important skill that we need to develop and gain acceptance too. A patient calls and says he cannot urinate
and he is having pain and he has known CKD. You see him but you are concerned
about potential distal obstruction:- A quick bladder sonogram in the office can
reveal the obstruction or distended bladder with urine and rather than an ER
visit, you can promptly send this patient to the Urologist for foley insertion
and home.
A dialysis patient tends not usually gain weight ( maybe 1kg
between treatments) , comes in slightly short of breath. A lung ultrasound done
by you reveal B lines and in multiple views suggesting fluid
overload. This allows you to take off
2kg today and patient feels better.
Alternatively, you would have done that anyway but also perhaps exposed
the patient to an X-ray that might have not been necessary.
My practice has changed with this revelation. Training our
faculty and fellows in this important skill- sonogram of the bladder and kidney
and lung US and IVC for volume status is important. In the era of declining
interest in nephrology, perhaps this skill might shed some excitement in the
field of nephrology. Lung US compares
favorably to CT scan for detection for pulmonary edema and might be better than
CXR.
The Emory course on sonogram might be the excellent course.
What I envision is more of a short burst of courses that can really help us use
this in clinical practice like we use our stethoscope, and not focus on using
it for billing/coding etc. purposes.
Let’s save lives by making a difference in our patients in a fast paced
manner , avoid ER visits and giving them a more comprehensive care in the
Nephrology clinic.
Here are some interesting references !
Great post as aslways
ReplyDeletesmall correction. The B lines which suggest interstitial syndrome on lung ultrasound are not synonymous with Kerley B lines.
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ReplyDeleteThat's a great experience of yours you have shared about the ultrasound machine and get a new way of your career, I appreciate for your hard work practice. Book the appointment for ultrasound on the best 3D 4D Ultrasound Packages on Blessings 3D 4D.
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