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/KumaraDosha Jul 21 '24

If there’s truly a protocol like that, then reporting the sonographer won’t get them in trouble and will still accomplish raising the issue to higher-ups. That being said, bro, there’s no official protocol; that would be a lawsuit smorgasbord. It’s a practice the current staff has apparently gotten used to and feel affronted by the sudden change. Happens to me, too; for some reason, this specific ED almost never orders arterial ultrasounds, so I’ve gotten used to the bliss of not doing them ever. So whenever some new doc orders one (or CTA is contraindicated and a familiar doc happens to need to see the arteries), I get pissed (and then suck it up, because I can’t say no and/or it makes sense that it’s needed). I understand why the sonographer was pissed, but they need to come in and do the thing. Because it’s not an official protocol for someone on call to say no to a testicle; that would be wild.

(Edited because so many typos.)

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u/wewoos Jul 21 '24

First, not a bro. Second, this entire thread is operating under the assumption that the OP is not an idiot and there is indeed a protocol - although of course a terrible one. But some hospitals (esp small hospitals) can have terrible protocols. Since nothing has yet gone wrong, they get away with it.

And for you to say no one would refuse to scan an ovarian/testicle torsion - that's just not always the case. I've had US techs balk at some stuff I'd consider standard, such as a transvaginal ovarian torsion rule out in a 15 yo, when both mom and patient are on board. It's both person and institution dependent.

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u/thedailyscanner Radiology Tech Jul 21 '24

Transvaginal might not always be needed. It’s a pretty tough exam for some patients. Usually we can see transabdominal well enough (depending on body habitus) to rule out torsion. I’d give it pause if they weren’t sexually active, and would do my best to get a diagnostic exam on top first. If that didn’t work and they were totally on board with the vaginal exam though, whatever. Your body, your choice. I think most would want to save their ovaries! But just FYI transvaginal isn’t always better. Some of those little suckers can only be seen transabdominal. A full bladder REALLY helps.

I have worked at one hospital that forbid us to ever do vaginal exams on patients who have never been sexually active, which was silly. But many of my coworkers followed that protocol to the letter.

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u/thedailyscanner Radiology Tech Jul 21 '24

Totally. I’ve come to learn that if I treat the vaginal portion like not a huge deal and more as a cool thing they can do to help save their organs, most are on board.