r/emergencymedicine • u/Former_Bill_1126 ED Attending • Jul 20 '24

Advice US won’t come in if pain >12hrs

Working at a new site, US techs are very picky, will not come in for torsion studies if pain is >12hrs. I talked her into coming in and she’s pissed af, said she knows I’m new and “I’ll learn the protocol”.

Am I in the wrong?

Edit: Does anyone support the US tech or rad protocol and do you have any studies or evidence to support this practice? I’m just wondering if they pulled this out of their ass or where they got the arbitrary 12 hour thing?

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u/StevenEMdoc Jul 20 '24 edited Jul 20 '24

"Testicular salvage in the first 12 hours is 90.4%, from 13 to 24 hours survival is 54.0%, and beyond 24 hours survival is 18.1%." Pediatr Emerg Care 2019; 35: 821.

https://pubmed.ncbi.nlm.nih.gov/28953100/

Still have a good shot at saving testicle beyond 12 to 24 hours.

Get techs name so you can document who refused to do test. Get Urologist support as provide literature about how US techs are inappropriately harming patients.

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u/KumaraDosha Jul 20 '24

But does this account for intermittent torsion? Pain for several days does make me narrow/roll my eyes as a sonographer, but intermittent torsion is a thing, so I’d come in (like I’d have a choice anyway, lmao). ALSO what about the fact that we need to see a dead testicle to confirm it needs to be removed??

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u/Former_Bill_1126 ED Attending Jul 20 '24

Idk why folks are downvoting you up above. I jokingly said the 11 hours of pain thing, but you’re 100% right we shouldn’t lie to each other. When you’re dealing with someone who hard stop refuses to come in when you place an order, that sucks, but ultimately the best solution can’t be to just lie.

Unfortunately your colleagues that don’t want to come in are the ones the make some folks feel they need to lie. But that is hella disrespectful to your profession to feel it’s necessary or appropriate to just lie, so I apologize for my comment.

And it’s ok for yall to roll your eyes at our orders 😂 some stuff I order is 100% ridiculous and cya and because I know the patient won’t be pleased if we don’t “do everything”. We really need an overhaul of the whole system.

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u/KumaraDosha Jul 20 '24

In my experience (I don’t know all other sonographers, so your mileage may vary), communication with the sonographer generally increases rapport and respect. At the very least it makes us feel more included as a part of the team helping the patient, and in general straight up honesty about the reason for exam (even if you can’t write it officially as such) helps us be more understanding. Definitely not mandatory for you to have to explain things to us, but we are quite grateful if you choose to do so! For example, saying an exam is a CYA situation, for me personally at least, helps me go, “Oh phew, he’s reasonable, and I can sympathize with this,” LMAO.

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u/Former_Bill_1126 ED Attending Jul 20 '24

I appreciate you commenting and giving a perspective from the US side! This is a new site for me, so it’s always annoying to be questioned so early on. I was tight with my crew at my old site 😂 especially with my fav US tech, we still text back and forth sometime. Hopefully when this crew realized I’m reasonable and don’t order an US on everything that walks through the door we’ll all be more chill with each other!

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u/KumaraDosha Jul 21 '24

I hope so; I know I would be. I’m also guilty of being too suspicious of doctors I haven’t worked with before, but I can do a 180 once I get to know them.