This is quickly becoming a hot topic (and frustrating problem) in my department.
Just in the last few months, our ER has ordered a good number of Pelvic ultrasounds for concerns that either (a) cannot/should not be addressed via ultrasound, or (b) definitely should be physically evaluated before an ultrasound is done.
Examples include: active miscarriages (with fetuses that are already in the cervix and/or vagina); foreign objects in vagina (or perceived objects); and more specifically, a geriatric woman who complained of blood on her TP after wiping, but she didn't know whether it was vaginal or rectal bleeding (but has h/o hemorrhoids).
When I've tried to get the ordering physicians to perform a pelvic exam prior to an ultrasound, I've gotten soooo much push back and BS excuses.
One doctor argued that it wasn't necessary, one said he performed the pelvic exam but both the nurse and the patient denied one being done, and my favorite: one physician initially argued "we don't have a place to do a pelvic exams for patients from the waiting room" (only half of our ER rooms were occupied at the time, any of them could have been used), and when I pushed for the pelvic regardless, she finally conceded and said "fine, but it'll be a while." I checked on the patient over TWO HOURS later and the patient said they still hadn't done a pelvic.
I'm curious about how other ultrasound departments handle this (particularly those who handle ER patients). Do you require pelvic exams up front? What do you and/or your supervisors think of situations like this? I've made this a poll but I would really like to know your detailed thoughts on the matter!
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source https://www.reddit.com/r/Radiology/comments/10xp0rg/to_my_fellow_us_techs_thoughts_on_physical_pelvic/
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