[HN Gopher] Could ultrasound replace the stethoscope?
___________________________________________________________________
Could ultrasound replace the stethoscope?
Author : fortran77
Score : 55 points
Date : 2023-01-21 05:53 UTC (17 hours ago)
(HTM) web link (www.newyorker.com)
(TXT) w3m dump (www.newyorker.com)
| mitchbob wrote:
| Archived: https://archive.ph/DQrMf
| haldujai wrote:
| Ultrasound can't penetrate lungs (bags of gas) so probably not,
| you can see things like effusions, pneumothoraces, and maybe a
| peripheral consolidation.
|
| Regardless, the stethoscope has (for better or worse) already
| been replaced for a while, at least for in-hospital care at
| larger US/Canadian community/academic settings, by chest x-ray
| and/or the increasing straight jump to CT pulmonary angiography.
|
| The amount of patients with respiratory complaints presenting
| acutely that leave hospital without radiology department imaging
| is probably <10% today.
|
| Physical exam skills as a whole are dying, abdominal pain is
| similarly a straight jump to CT or US these days, often before a
| physical exam is even documented (was it even done?). Even more
| true for gynaecological concerns (not debating whether or not
| this more ethical, but it's very rare to see ER physicians
| perform a vaginal exam these days before ordering ultrasound).
|
| In terms of the utility of POCUS, the heterogeneity in training
| has been a barrier to adoption by clinicians in Canada (I imagine
| similarly in the US). While POCUS is performed by ER/internal
| medicine, patients are still being sent to radiology for formal
| imaging before definitive management takes place, even for more
| straightforward cases like gallstones and kidney stones.
| Presently, very few POCUS studies are formally uploaded to a
| patient's record in my current hospital (largest institution in
| Canada) although that is increasing and clinician competence at
| POCUS is slowly rising.
|
| The FAST exam in trauma settings is probably one of the only
| reliable POCUS uses at the moment, and echocardiography.
| ayewo wrote:
| For other similarly confused readers as I was:
|
| - POCUS = Point Of Care Ultrasound
|
| 1: Thanks to https://news.ycombinator.com/item?id=34464971
| maxerickson wrote:
| Is that maybe partly because the billing on CTs is completely
| out of step with the apparent cost?
|
| To the extent that there are regulatory hurdles to buying and
| operating a CT suite (and there are such hurdles in many
| states), there should be regulation that ensures that the
| billing is reasonable. Instead, you pay like a whole number
| percentage of the cost of running the damn thing for a year.
| haldujai wrote:
| I can't speak to US billing practices on the facility fee
| side, in general though Canadian fee codes for the
| professional fee/reporting component are higher than the US.
| The tendency to proceed to CT early is largely because:
|
| 1. A lot of ED centres are financially rewarded if they keep
| time to disposition within target (either directly in Canada
| or for throughput in US). If the CT identifies a cause for
| admission and a service is consulted that patient is
| officially "discharged" from ED even if they are physically
| still there waiting for the specialty consultation /
| admission.
|
| 2. Generally unjustified malpractice fears in both US/CAN,
| the theoretical risk of cancer down the line is impossible to
| tie to an individual imaging study, but there is a lot of
| fear for missed diagnosis. Despite risk scoring systems for
| things like pulmonary embolism I see a lot of patients with
| pneumonia on X-ray (I.e. an explainable cause for chest pain)
| getting these studies "just to be safe". Overalll positivity
| rates on these studies is 1-2%, despite how much this imaging
| has become utilized (something like 10-20x increase over the
| last 10 years) we have not seen corresponding reductions in
| mortality suggesting overimaging, but research is ongoing.
|
| As a radiologist I try my best to reject unnecessary scans,
| but it's difficult to do so when a clinician is telling you
| "I'm scared about deadly condition x". When they're younger I
| can apply the radiation risk consideration and suggest shared
| decision making, in some outlandish requests (I was asked to
| CT an 18 year old male with a fever, negative blood work and
| zero risk factors for PE, so likely viral illness or asthma)
| I outright refuse but those cases are few unfortunately as
| most presentations are elderly patients.
| maxerickson wrote:
| The radiologist interpretation fee is almost always like
| $20 straight up, that part of it seems to be working just
| fine.
| haldujai wrote:
| Do you know what the facility/hospital fee component is
| out of curiosity?
| maxerickson wrote:
| For a head CT scan I had a few years ago, where the ER
| doctor likely ordered it to rule out an abscess in my jaw
| (I didn't interview her to understand her thinking), I
| paid ~$2000 for the scan, like $700 for the ER visit,
| like $500 to the doctor and like $20 to the radiologist.
| The doctors billed separately.
|
| It was just a sinus infection that was irritating a
| cavity, which was making my whole jaw ache to where I
| couldn't sleep (overnight Saturday), and I went in out of
| some combination of panic and concern that it was
| escalating.
|
| It rankles me to no end that they up charged the visit
| because of the consult, where what really happened is the
| doctor ordered a test that allowed someone else to do a
| definitive diagnosis and more or less completely removed
| their liability (both by removing uncertainty and by
| shifting it). I also can't begin to reconcile the cost of
| the scan itself (but don't really have any information
| about their actual costs). I dunno, maybe it did actually
| cost them a bunch of money to wheel me over to the CT
| room and back.
| haldujai wrote:
| Yeah that's insanely upcharged. Being generous a high end
| ER CT scanner is in the $200,000 to $300,000 range.
| Contrast is a few bucks. Technologist + porter are
| generously paid $100 combined + whatever you want to give
| for overhead, noting a lot of these employees are
| officially "part time" to save on benefits.
|
| Given that an average ER scanner does something like 80
| studies a day, sounds like they're depreciating over a
| week...
| maxerickson wrote:
| That matches the 'ballpark' costs I had sort of assumed.
|
| It's a small town hospital, so I wouldn't be surprised if
| their volume is quite a bit lower than that. Which still
| doesn't get to the cost being reasonable. 35,000 people
| in the county, with some of those people being closer or
| equal distance to other facilities.
| cperciva wrote:
| _Regardless, the stethoscope has (for better or worse) already
| been replaced for a while, at least for in-hospital care at
| larger US /Canadian community/academic settings, by chest x-ray
| and/or the increasing straight jump to CT pulmonary
| angiography._
|
| In hospitals, sure, but GPs don't have access to those. At
| least in my experience "is this a bad cold or is it bronchitis"
| gets answered with a stethoscope.
| n8henrie wrote:
| Was mostly with you until comments about FAST. What?! Only
| validated in shock, I'd say one of the least sensitive and
| least important tests we do for questionable reasons, since
| every trauma goes to the donut of truth anyway.
|
| I would say biliary, echo, ocular, peritonsillar, procedural
| (CVC, paracentesis, thora), soft tissue, early obstetric all
| highly reliable in my practice environment. Then again, our
| small department is almost all recently trained and we have
| very limited radiology options so we get a lot of practice.
| rscho wrote:
| > every trauma goes to the donut of truth anyway
|
| Yes, and that's also not supposed to work like that. ATLS
| says FAST+ -> OR without donut. As an anesthesiologist, I can
| tell you it's very frustrating to lose patients because you
| spent an hour and a half in the ER because the trauma surgeon
| doesn't have the balls to open the patient without a CT. Lost
| a 20 yo, probably in good part due to that.
| haldujai wrote:
| I'm impressed by your comfort level and curious about the
| specific indications you're doing, would appreciate your
| perspective as I'm in a tertiary care/level 1 centre so POCUS
| practitioners aren't as skilled here imo. The training in
| Canada is also very heterogeneous (some do a 1 year
| fellowship while others do a weekend course with standardized
| patients). One of the issues to keep in mind with POCUS is
| monitoring outcomes / comparing with gold standards (whether
| that's formal imaging or operative reports). In radiology we
| very often get feedback in addition to M&M +
| multidisciplinary rounds to maintain quality, anecdotally
| I've found this to be more variable in POCUS-heavy practices.
|
| 1. Regarding FAST
|
| There is a certain amount of variation by centre, but it is
| definitely not true that every trauma goes to CT first, most
| do but it's not infrequent (forgive my usage of this) to go
| straight to OR for damage control lap and CT after,
| particularly with penetrating trauma or non-responding
| hemodynamically unstable patients. At my hospital (level 1
| trauma) a positive FAST + instability generally goes straight
| to OR, you may argue the FAST is noncontributory and these
| patients should go straight to OR anyway but it's certainly
| routinely performed.
|
| 2. Procedural - completely agree, should be highly reliable
| for all physicians. It's arguably malpractice to do
| procedures blind these days.
|
| 3. Early OB - are you performing TVUS? This is uncommon, and
| if you are that's phenomenal. Are you just doing r/o ectopic
| or formal dating US? CRL and MSD can be challenging to
| measure accurately, but if you're doing a lot and getting
| followup from rads/OB it's certainly possible to be reliable
| at this.
|
| 4. Soft tissue - as in abscess or MSK? MSK ultrasound is very
| challenging and I would be enormously impressed if you are
| doing tendon tears reliably (other than full thickness) as
| many radiologists are uncomfortable with these today. Do you
| have MR or formal radiology follow up reads to assess your
| sens/spec?
|
| 5. Biliary - Assuming you mean cholecystitis and gross bil
| dil, glad to hear this is becoming comfortable for POCUS
| practitioners. My centre has a formal POCUS fellowship but
| the surgeons don't rely on their reads, they will see in
| consult based on POCUS but always demand a radiology
| examination prior to operating. I hope that this will change
| in the near future for chole. I'd be hesitant as a patient
| getting scanned for focal bil dil (aka ?cholangio) or PSC by
| POCUS, but I doubt that's a common indication for you.
|
| 6. Echo - Assuming you mean for ER indications? Are you still
| sending for formal echos or comfortable ruling out all
| valvular disease? Our cardiology fellows who do bedside echo
| in CCU still seem to get formal reads.
|
| 7. Peritonsillar - I can't even remember the last time I've
| reported one of these, we have dedicated ER CT scanners 24/7
| so they always go straight to CT. Is this an accurate test?
|
| Overall happy to hear POCUS is more reliable in some places,
| I dream of the day I can stop reporting acute care US.
| n8henrie wrote:
| Also, I'd say respiratory complaint with acute presentation
| (meaning to ED) less than 1% don't get imaging. Maybe 10% if
| you include urgent care or clinics.
| haldujai wrote:
| Haha I was being a bit conservative, but my centre has UC in
| the tertiary care hospitals and I don't see many asthma
| indications so I assume that population is not getting imaged
| routinely.
| KaiserPro wrote:
| no.
|
| Not until a ultrasound can easily and quickly identify a heart
| murmur or crackle of lungs indicating the type of lung infection.
| (as in put it on, wait for 10 seconds)
|
| Look, ultrasounds are slow, narrow, high resolution tools.
| Scanning your lungs with an ultrasound takes a fucking age, and
| requires a lot of training to get good results _and interpret_
| them. if you at the GP /family doctor, and you want to eliminate
| symptoms quickly, the stethoscope is super quick.
|
| sure, if you are looking for fluids to drain, ultrasound is
| great. But you are looking for something and you need to be
| precise so you can shove the drain in the right place.
|
| my doctor friend says: "ultrasounds are great, but they are
| really hard to understand. I used to do brainscans on newborns,
| and I fucking hated it" (the inference being that getting a good
| image was tricky and fatiguing)
| _qua wrote:
| How do you think auscultation tells you the "type of lung
| infection"? Really the only thing A stethoscope is better at
| then x-ray and ultrasound for the lung exam is detection of
| wheezing. It is rare that auscultation actually changes my plan
| for a patient. I have seen enormous pneumothoraces in patients
| who had almost completely normal lung sounds. Of course easily
| detectable on x-ray and ultrasound.
| haldujai wrote:
| I personally hate reporting NICU brains (not a pediatric
| radiologist), even for sonographers it's usually just a subset
| who are qualified to do them. Slightly poor technique can make
| a huge difference in vascular assessment and if your settings
| are off you can make it look like there is hemorrhage.
|
| US reports are so heavily based on what the sonographers saw,
| and documented, so there is huge operator
| dependency/variability.
|
| I'm not sure how old your friend is, but as a recently trained
| rad I have little confidence in my own skills for neonatal
| brains to be honest, older rads had more time to develop their
| skills while we are much more exposed/comfortable with cross-
| sectional imaging these days and dependent on sonographers. I
| feel a lot better reporting a rapid MR protocol with the
| neonate in bundle and wrap (no anesthesia).
| [deleted]
| n8henrie wrote:
| I think ultrasound already has replaced the stethoscope in the
| ED. ED physicians in the US basically all get pretty extensive
| training with POCUS. I truly love and practice the physical exam,
| but even in my 30s feel like some kind of dinosaur in this
| respect. I've written letters of profound gratitude to my
| ultrasound director, as probably the most impactful training in
| preparation for my rural practice.
|
| I have literally _never_ had an inpatient colleague -- from rural
| to academics -- admit a patient for eg pneumonia without an
| X-ray, no matter how young and otherwise healthy or how
| convincingly the history and vitals match my carefully documented
| auscultation, egophony, and percussion. It 's a waste of
| everyone's time to even try. As a result, many of my colleagues
| skip the middle man and don't bother with much exam. Some don't
| even bring a stethoscope to work anymore.
|
| Which makes me sad.
| haldujai wrote:
| I'm SHOCKED to read a staff physician, especially as young as
| you are, is performing egophany and percussion. If your
| comments didn't so strongly suggest that you are a very
| competent and diligent physician I would honestly call BS.
|
| Good for you though, I haven't seen these exams performed done
| since the clinical skills course during preclerkship of medical
| school. It's honestly a running joke in my medical friend
| group, when we used to teach the medical students we'd have to
| pull out a copy of Bates and remind ourselves how to do those
| and whispered pectoriloquy haha.
| lukko wrote:
| I think CXR in pneumonia is justified - if there's
| deterioration it's very helpful to have imaging at admission
| and consolidation on a CXR is usually expected for diagnosis
| (in UK), especially if the patient is requiring oxygen and sick
| enough for admission. I totally get what you mean though -
| unfortunately clinical examination is not trusted and valued. I
| guess POCUS is sort of just an extended clinical examination
| with more hardware...
| notorandit wrote:
| No. For sure the stethoscope cannot replace sonography. There are
| a number of situations where a stethoscope is much better than
| any sonograph. Due mainly to the fact that the former is a
| lowtech device
| l- wrote:
| Absolutely! A tool for looking at the chest does not compare when
| the case calls for a stethophone.
| aaron695 wrote:
| Cheap Ultrasound should have won the Tricorder X Prize, but they
| made the conditions impossibly stupid, literally Star Trek sadly
| -
|
| https://en.wikipedia.org/wiki/Tricorder_X_Prize
|
| Ultrasound goes to other industries like helping the true poor
| with smallholder animal husbandry to the billion dollar
| construction industry.
|
| The sensors just need to be made cheap and attachable to cell
| phones.
| JPLeRouzic wrote:
| Was some of these competitors' design open sourced? Thanks!
| hulitu wrote:
| > Could Ultrasound Replace the Stethoscope?
|
| Can a slicing machine replace a knive ? Yes but it is too heavy
| to carry around.
| rscho wrote:
| We've got pocket ultrasound machines, now.
|
| https://vscan.rocks/
|
| It's one instance among many of the same.
| n8henrie wrote:
| Butterfly also pretty sweet
| amelius wrote:
| Interesting, where can I read the product reviews?
| sergers wrote:
| Clarius mobile ultrasound has been the news lately.
|
| https://clarius.com/reviews/
|
| They were also part of AMD' CES keynote on health with
| their chips. https://youtu.be/OMxU4BDIm4M?t=3831
|
| Great story highlighted how having mobile ultrasound has
| helped this rural community doctor
| haldujai wrote:
| Butterfly iQ is another one worth checking out and
| popular with my ER colleagues.
| amelius wrote:
| > popular with my ER colleagues.
|
| In the western world, isn't it preferable if ultrasounds
| are left to specialists? I'm wondering if the use of
| cheap portable devices is part of a trend of improving
| healthcare, or just making it cheaper (or both).
| haldujai wrote:
| Point-of-care ultrasound in the Western world is a hot
| trend.
|
| There's the idea that clinicians can use this tool to aid
| in diagnosis as an extension of the physical exam (e.g.
| I'm worried this patient might have a kidney stone, let
| me slap the ultrasound on their back and check).
|
| The pitch has been that it would increase throughout and
| alleviate the strain on radiology departments giving us
| and our sonographers more time to do more complex imaging
| studies.
|
| In practice, the training and skill of clinicians ranges
| from borderline negligent to amazing, leaning more
| towards the lower end. Given this heterogeneity, it is
| still yet to be accepted as a true diagnostic test in
| many places where a radiology department exists so the
| purported benefits aren't being realized.
|
| Ultrasound is harder than it looks, and unfortunately a
| lot of physicians just took a weekend course to get
| certified. In the hands of an adequately trained
| physician, I feel it's very safe for clinicians to
| perform basic scans and that it would safely expedite
| patient care while alleviating burden on radiology so
| overall benefiting the system more than a cost thing.
| viraptor wrote:
| Those are used in a local clinic. I'm told they're not as
| high resolution as other options, but good enough for GPs
| + doing occasional obs scans. They're happy with it.
| There was some annoyance about choosing the model -
| there's a separate lightning and usb-C version, but at
| least now that will be finally unified.
| haldujai wrote:
| Good to know, I don't have personal experience with POCUS
| devices (radiologist). I think traditionally Butterfly
| was much cheaper than Clarius, and had better software
| assistance / AI for things like TGC sliders and gain.
| Looking at the Clarius offering now it seems much closer
| in pricing and they've improved their software package.
|
| Surprised to hear that they have separate USB-C and
| lightning offerings in 2022/2023, seems archaic.
| Gatsky wrote:
| TLDR: Yes.
|
| An inordinate amount of time is spent teaching auscultation
| (using a stethoscope) to doctors. The diagnostic performance
| isn't that great even under ideal conditions. Having bedside
| ultrasound would really improve things for patients, and save
| money on unnecessary tests and treatments.
| haldujai wrote:
| Thats a very generous view on the current state of POCUS. I
| don't believe this has been studied yet but the % of patients
| who undergo POCUS in the ED (which is billed for) and leave
| without formal imaging in the radiology department (also billed
| for) is probably in the single digits.
|
| Irrespective of their findings, clinicians are not yet
| confident enough to discharge their patient on the basis of
| their negative POCUS nor are surgeons confident enough in the
| clinician skills to operate on positive POCUS findings (except
| FAST). Hopefully this will slowly improve over time,
| particularly if AI can play a role in procuring adequate
| images, but ultrasound is a hard skill to master (sonographers
| do this day in and day out, a lot more skillful than myself as
| a radiologist let alone a clinician with an underpowered
| POCUS).
|
| Conversely, there is a non-trivial amount of unnecessary
| imaging generated as a result of POCUS findings (perhaps most
| significantly for aortic dissection which is a high dose CT
| scan). Out of ~100 CT studies I've reported that come with the
| history 'dissection/intimal flap on POCUS' 0 have been
| positive, and had the clinician gone purely on the clinical
| picture + labs they would have probably not ordered the CT in
| most of these cases.
|
| Also ultrasound can't penetrate lungs.
| Gatsky wrote:
| All good points, but you would surely agree that despite that
| it is better than the stethoscope? Particularly in ambulatory
| care rather than ED, where there isn't a CT scanner down the
| corridor. ED docs are forever trying to diagnose aortic
| dissection for some reason...
|
| I thought POCUS was useful for pleural effusion and
| consolidation, but you'd know better than I do.
| slaw3 wrote:
| I use a stethoscope to listen for airflow in the lungs and
| murmurs of the heart. In both cases I would still order
| more imaging before finalizing a treatment plan unless it
| is for something emergent. Ultrasound cannot assess airflow
| well so I don't see it replacing the stethoscope in that
| regard.
|
| My unpopular opinion is that point of care ultrasound is a
| fad and will eventually be phased out of physician
| workflows. This is because I haven't seen it actually
| change someone's medical decision making. More often,
| people use it as a means to justify why they haven't
| actually made a treatment decision yet.
|
| The only way I could see it have adoption is if actual
| radiologists (which as of now are the only physicians that
| went through standardized examination confirming competency
| in reading ultrasound studies) started doing rounds in the
| ER and on the wards.
| haldujai wrote:
| Abstractly I wouldn't mind that, but it would take
| massive system level changes to make this feasible. We
| used to do ICU rounds are my institution but we're
| struggling to keep up with the ever increasing volume of
| cross sectional imaging studies. Our outpatient X-rays
| are going unreported for > 1 month. Even some routine MRs
| embarrassingly.
|
| Volumes are getting insane, in some places I've worked
| I've had to keep up with 80+ CTs and 100 x-rays on an 8
| hour evening ER/inpatient shift (never leave at 8 hours).
| haldujai wrote:
| If you need imaging for pneumonia / consolidation it's
| definitely better to X-ray (very accessible), you may get
| lucky and see a peripheral pneumonia if it's dense enough
| but the negative predictive value isn't there as you have
| very little depth of penetration.
|
| Pulmonary edema is presently still X-ray preferred as it's
| easier to compare cardiomegaly and pulmonary vasculature
| with priors, as opposed to US images which are operator
| dependent and likely not saved. There is increasing
| research on cardiac/caval measurements as surrogates for
| CHF but the standard measurements haven't been fully
| developed to be clinically ready as the sole investigation,
| I expect one day in the not too distant future this will
| change.
|
| Pleural effusions go either way, as an initial
| investigation you'll usually still want the X-ray to
| evaluate for parenchymal disease and CHF so why do two
| tests. With that said we drain effusions under US guidance
| so if that's your only clinical question for sure POCUS is
| great, I would say that's an uncommon scenario though
| unless the patient is known for chronic/malignant effusions
| and you may only be assessing for reaccumulation and
| planning drainage.
|
| Pneumothoraces on US still need X-ray confirmation and to
| accurately assess size as the sliding sign isn't that
| reliable yet.
|
| Given how broad most differentials are for dyspnea it's
| hard to find a patient where US (either in radiology or
| POCUS) is satisfactory as a single investigation when
| concerned about lung/pleural disease. It's awesome for
| cardiac stuff like wall motion abnormalities and gross
| dilatation/dysfunction in the acute setting, but you'll
| still want a formal echo for accurate size measurements. At
| my institution we still have echocardiographers on backup
| call for the cardiology fellows, although they're being
| called in less and less.
|
| Abdominal imaging is way more of a crapshoot. Acutely
| presenting patients are often unwell, have large body
| habitus, and acquiring adequate images is hard even for us.
| If you're in a place without emergent/urgent US access it's
| certainly better than nothing. You would certainly never
| diagnose malignancy or workup a mass based on POCUS, this
| can be really hard even for radiologists + sonographers.
|
| Personally, I hope clinician skills reach the point where I
| don't do (or do significantly less) acute US studies so
| this isn't gatekeeping at all. I would gladly give up the
| work. A lot of the issues stem from how POCUS was
| implemented, currently it is very unstandardized and you
| can get certified after a weekend course in some places and
| are being taught by other clinicians. It would be better if
| they rotated with our sonographers to learn the skills in
| my opinion.
|
| Edit: I don't disagree re: stethoscope but it's already
| been replaced by X-ray in any facility with one (which is
| most places), chest imaging is a bad example of where POCUS
| will be useful for the above reasons. Increased skills at
| biliary, renal and testicular pathology as well as echo are
| way better examples and instances where stethoscopes are
| already outdated. When I was an intern 5 years ago we had
| already moved past auscultating murmurs, which are
| generally not acute, and you would still get a formal
| outpatient echo for accurate measurements (these take a
| while and you need to be really good at measuring, slight
| obliquely can significantly alter values).
| unwind wrote:
| Here, POCUS = point of care ultrasound.
| philiplu wrote:
| Thanks for that. So what does ED refer to? Emergency
| Department? Synonym for ER?
| haldujai wrote:
| Sorry I should have explained to the acronyms I was
| using, bad habit.
|
| Yeah exactly. Apologies I use them inconsistently and
| interchangeably, Epic's electronic medical record system
| changed it to ED for some reason.
| AussieWog93 wrote:
| Why would you want to replace something that's light, fits around
| your neck, requires no power or setup and can complete the
| diagnosis in under a minute with an AI-connected ultrasound
| machine?
| nadermx wrote:
| For science
| Findecanor wrote:
| Sometimes a simple, portable tool is the best tool for the job.
| Sometimes ultrasound is better. Stethoscopes are not just used
| for listening to the heart, but also to the lungs and the
| intestines.
| haldujai wrote:
| Bowel auscultation has zero clinical utility.
| Findecanor wrote:
| Post bowel-op two weeks ago, my doctor used a stethoscope to
| hear if my bowels had started up again.
| haldujai wrote:
| Right, people do it but it has zero clinical utility as the
| history is way more significant (are you passing
| gas/stool).
|
| If you had an ileus (non moving bowel) for 2 weeks you
| would know without auscultating. If you're passing gas or
| having bowel movements, the presence or absence of bowel
| sounds means nothing.
|
| If you're not passing gas or having bowel movements after 2
| weeks the auscultation findings are similarly meaningless
| as this is a very concerning presentation.
| lukko wrote:
| but what about tinkling bowel sounds as a sign of
| obstruction?? lol, agreed - is completely useless and of
| no clinical value
| haldujai wrote:
| I got called once at 4am to perform an urgent CT scan on
| a patient with "borborygmus" as a junior resident.
|
| At the time I was unfamiliar with this term (which means
| a rumbling or gurgling sound in the belly) and did not
| for a moment consider that a nephrologist was listening
| to someone's belly in the middle of the night. Given how
| scary the word sounded I performed a stat CT.
|
| I googled it after the scan was completely normal. One of
| the most embarrassing and angering moments of my medical
| career so far. I swore since that day I would die
| fighting the crusade against those demons who auscultate
| bowel sounds.
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