Ultrasound: the triage tool in the emergency department: using ultrasound first

Abstract

Ultrasound in the emergency department has long been recognized as a powerful screening and diagnostic tool for both physicians and radiologists. In the emergency department, since time is of the essence, it becomes a critical tool in triaging patients. Over the years, ultrasound has gained several advantages over other modalities because of its non-ionizing radiation, portability, accessibility, non-invasive method and simpler learning curve. As a result, ultrasound has become one of the most frequently used diagnostic tools in the emergency department by non-radiologists. The value of ultrasound is implemented in every acute ailment in the emergency department such as trauma, acute abdomen, acute pelvic pain, acute scrotal pain, appendicitis in children and acute deep venous thrombosis. Our objective is to discuss the benefit of using ultrasound as the primary modality for each of these diseases.

Figure 1.

A 30-year-old female with a history of asthma complains of intermittent right upper quadrant pain. The patient reports the pain radiating to the back and worse with eating and tenderness in the right upper quadrant upon inspiration (Murphy's sign). The patient also indicates nausea and vomiting. Greyscale image of the right upper quadrant demonstrates a distended gallbladder with multiple stones, gallbladder wall thickening and pericholecystic fluid. The patient was taken to the operating room and found to have acute cholecystitis.

Figure 2.

Ovarian torsion: a 42-year-old female presents to the emergency department with left lower abdominal pain for two days. The colour flow Doppler ultrasound of the left adnexa demonstrates an enlarged left ovary with absence of follicles and a haemorrhagic cyst and absence of colour flow Doppler. This is suggestive of ovarian torsion.

Figure 3.

Testicular torsion: a 48-year-old male complains of constant right testicular pain for 2 days. He denies any recent trauma. The colour flow Doppler image shows complete absence of flow within the right testis and decreased echogenicity of the right testis. The patient was taken to the operating room and found to have complete torsion and necrosis of the right testis.

Figure 4.

Acute appendicitis: a 13-year-old male presents to the emergency department with periumbilical pain for 3 days. He had multiple episodes of vomiting. He has a decrease in appetite. He demonstrated rebound tenderness and guarding at McBurney's point. The colour flow Doppler ultrasound of the right lower quadrant demonstrates a dilated appendix measuring 0.9 cm in length with an appendicolith. There is increased vascular flow surrounding the appendix. The patient was taken to the operating room and found to have acute appendicitis.

Figure 5.

Acute deep venous thrombosis in the calf veins: a 79-year-old female with a history of chronic kidney disease, hypertension and frequent hospitalizations presents with new onset of hypoxia and high probability of pulmonary embolism. The colour flow Doppler ultrasound of the left lower extremities was performed. There is non-compressibility of the left popliteal vein with lack of augmentation of flow (not shown).