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Ok, Here's a case to introduce a question: 80-something year-old female, RTA. Fractured sternum (fragile from steroids for asthma), grazed (non-fractured) shins. GCS=15 throughout. No head injury. No abdo or pelvis problems clinically. No peripheral neuro loss. Trauma series: NBI. Arterial Gases good. Stable obs throughout, once analgesed and oxgygenated. 3-4 hours after arrival, admitting team decide they want to do a DPL, despite patient remaining stable and normal abdo USS a few hours earlier. Question: My (slightly out-of-date) ATLS manual doesn't mention abdo USS in acute trauma, but now most DGHs enjoy the support of their radiology colleagues in getting quick USS ;-) is there any advantage of DPL, which, to paraphrase P Freeman (Auckland, NZ) at this year's BAEM conference, is less sensitive, less specific and more invasive than USS? Answers on a postcard please.... Apparently in Europe and USA, DPLs are less used these days. I've certainly noticed an increasing preference for USS rather than DPLs over the last few years, which makes the above case even more interesting. On the same subject, the general feeling at BAEM was that only in large units seeing lots of cases would it be justified to have senior A&E staff learning to wield Ultrasound probes, since the number of investigations required to maintain accuracy would be impractical in most units. Apart from trauma, USS in A&E could be useful for AAAs and ?ectopics. Any comments? ps: a senior nurse was once overheard explaining to a student nurse attending a trauma call, that "the surgical registrar is about to perform a diagnostic perineal lavage"! Does anyone have any personal experience of one of these?