Free Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic Pregnancy

Moore, Chris; Todd, William M.; O'Brien, Elizabeth; Lin, Hsueh-Chun

doi:10.1197/j.aem.2007.04.010

Cited by 69 publications

(17 citation statements)

References 8 publications

(7 reference statements)

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“…A high index of suspicion for ruptured ectopic pregnancy is required, and ultrasound findings can help to increase clinical suspicion of ruptured ectopic pregnancy (free peritoneal fluid, empty intrauterine cavity, adnexal mass) as well as haemodynamic instability because of the resultant haemoperitoneum. Presence of free fluid in Morison's pouch may predict the need for operative management [6]. Ruptured ectopic pregnancy combines two limitations of care found in the maritime medicine environment -absent surgical capabilities, and lack of blood products.…”

Section: Discussionmentioning

confidence: 99%

A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound

Boniface

Sikka

Page³

et al. 2020

International Maritime Health

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Cruise ships travel far from shoreside medical care and present a unique austere medical environment. For the cruise ship physician, decisions regarding emergency medical evacuation can be challenging. In the event that a passenger or crew member becomes seriously ill or is injured, the use of point-of-care ultrasound may assist in clarifying the diagnosis and stratifying the risk of a delayed care, and at times expedite an emergent medical evacuation. In this report we present the first case reported in the literature of an emergency medical evacuation from a cruise ship triggered by handheld ultrasound. A point-of-care ultrasound performed by a trained cruise ship physician, reviewed by a remote telemedical consultant with experience in point-of-care ultrasound, identified an ectopic pregnancy with intraabdominal free fluid in a young female patient with abdominal pain and expedited emergent helicopter evacuation from a cruise ship to a shoreside facility, where she immediately underwent successful surgery. The case highlights a medical evacuation that was accurately triggered by utilising a handheld ultrasound and successfully directed via a tele-ultrasound consultation. American College of Emergency Physicians (ACEP) health care guidelines for cruise ship medical facilities should be updated to include guidelines for point-of-care ultrasound, including training and telemedical support. (Int Marit Health 2020; 71, 1: 42-45)

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Section: Discussionmentioning

confidence: 99%

A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound

Boniface

Sikka

Page³

et al. 2020

International Maritime Health

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“…PPOCUS may play a more useful role in determining patients needing prompt operative care – in those with ruptured ectopic pregnancy. Rather than focusing on identifying an IUP, visualisation of fluid in the hepatorenal space (Morison’s pouch) by PPOCUS has been found to be strongly predictive of the need for operative intervention with a positive likelihood ratio of 112 [11]. In an appropriately trained EP, PPOCUS takes less than 5 min to complete [11].…”

Section: Discussionmentioning

confidence: 99%

“…Rather than focusing on identifying an IUP, visualisation of fluid in the hepatorenal space (Morison’s pouch) by PPOCUS has been found to be strongly predictive of the need for operative intervention with a positive likelihood ratio of 112 [11]. In an appropriately trained EP, PPOCUS takes less than 5 min to complete [11]. A recent meta-analysis found that there are significant time savings with PPOCUS, especially at night where access to formal departmental US is limited [12].…”

Section: Discussionmentioning

confidence: 99%

Acute pelvic pain following miscarriage heterotopic pregnancy must be excluded: case report

2019

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BackgroundHeterotopic pregnancies are increasing in prevalence and this case highlights the importance of excluding the diagnosis in patients with pelvic pain following miscarriage. A known pre-existing intrauterine pregnancy can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy.Case presentationIn this report, we describe a case of spontaneous heterotopic pregnancy in a woman who had initially presented with pelvic pain and vaginal bleeding, and was diagnosed on pelvic ultrasound with a missed miscarriage; a non-viable intrauterine pregnancy. She re-presented 7 days later with worsening pelvic pain and bleeding, and a repeat pelvic ultrasound identified a ruptured tubal ectopic pregnancy in addition to an incomplete miscarriage of the previously identified intrauterine pregnancy. She underwent an emergency laparoscopy where a ruptured tubal ectopic pregnancy was confirmed.ConclusionBeing a time critical diagnosis with the potential for an adverse outcome, it is important that the emergency physician considers heterotopic pregnancy as a differential diagnosis in patients presenting with pelvic pain following a recent miscarriage. The same principle should apply to pelvic pain in the context of a known viable intrauterine pregnancy or recent termination of pregnancy. A combination of clinical assessment, beta human chorionic gonadotropin levels, point of care ultrasound and formal transvaginal ultrasound must be utilized together in these situations to explicitly exclude heterotopic pregnancy.

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“…There was strong evidence to support its use with significant heterogeneity within the pooled data [6]. A prospective observational study looked at the presence of fluid in the hepatorenal space (Morrison's pouch) -its identification signalling the likelihood of requiring operative management; nine out of 10 identified patients using PoCUS went on to require operative management after formally correlated investigations [7]. Chest physicians utilise PoCUS in performing thoracocentesis.…”

Section: Review Pocus In Practicementioning

confidence: 99%

The Role of Point of Care Ultrasound (PoCUS) in Orthopaedic Emergency Diagnostics

Oluku¹,

Stagl²,

Cheema³

et al. 2021

Cureus

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Ultrasound has been described as the “stethoscope” of the radiologist; its ability to aid in clinical diagnosis with both static and dynamic imaging has allowed fast and accurate diagnosis. However, traditionally unlike a stethoscope, a large and bulky ultrasound machine made it difficult to use portably in a hospital environment where patients can be scattered across a hospital. With the development of innovative ultrasound technology, Point of Care Ultrasound (PoCUS) can readily be carried by a clinician to make a quick and timely diagnosis. In this review article we look at the uses of PoCUS within orthopaedic emergencies. Diagnosis in orthopaedics often requires further imaging beyond history taking, clinical examination and plain radiographs. In these cases PoCUS can be useful for ruling out occult fractures, diagnosing joint effusions and tendon ruptures. By aiding a speedy diagnosis, we can reduce unnecessary immobilisation, reduce inpatient stays, introduce early mobilisation and reduce harm to patients. With PoCUS becoming increasingly cheaper and more portable we feel this really can become the stethoscope of an orthopaedic surgeon.

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Free Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic Pregnancy

Abstract: Free intraperitoneal fluid found in Morison's pouch in patients with suspected ectopic pregnancy may be rapidly identified at the bedside by EP-performed US and predicts the need for operative intervention.

Cited by 69 publications

References 8 publications

A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound

A cruise ship emergency medical evacuation triggered by handheld ultrasound findings and directed by tele-ultrasound

Acute pelvic pain following miscarriage heterotopic pregnancy must be excluded: case report

The Role of Point of Care Ultrasound (PoCUS) in Orthopaedic Emergency Diagnostics

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