In the Netherlands, the majority of Emergency Physicians unfortunately do not use ultrasound frequently at this moment. One of the arguments I often hear is: “I don’t have the time to perform ultrasound at my busy Emergency Department (ED), because there are to many patients to take care of”. Hopefully my case will prove otherwise.
A few months ago, this 40 year old guy from Poland came to our ED. Our secretary called the triage nurse to inform ‘this man doesn’t look good’, maybe you can pick him up. As the nurse went to call for this patient, he indeed didn’t look well and that was not because the use of alcohol. He looked pale and diaphoretic all over, but didn’t speak a word English, German or Dutch. As they walked to a empty room, the nurse shouted for my help as they always do. While I was doing nothing except drinking coffee at my busy ED, she said: Please come over immediately ‘this man doesn’t look good’. I carefully watched the nurse (and the patient as well) and followed them into the room with my ultrasoundmachine, because this man was indeed looking awful. As she put the man on the monitor to get his vital signs, it was my time to shout. I ordered for ECG and regular bloodtest, because he might have STEMI. While I was preparing my device I noticed the man holds his both hands on his belly. Instead of performing an cardiac exam first, I choose to do abdomen (see fig 1 and 2). I diagnosed free fluid in his belly before the needle (for bloodtest) was actually in this specific patient. Later on, we found out that he was using brufen for a week because of backpain and the CT-scan revealed an hole in his stomach, so he went for surgery and did well afterwards.
I’ll guarantee, everything I just wrote down was for real (except the nurse was checking me out obviously).
I hope this case will stimulate you all to perform ultrasound more rapid and more often in future! Those of you, interested in learning ultrasound, you can always contact me for a four week ultrasound rotation at Sint Franciscus Gasthuis in Rotterdam. Although we are fullly booked until april 2015.
All the best,