"This is another reason why it is pretty difficult to defend running an ED
without a scanner these days. Ultrasound is cheap and safe. Why not do it?"

Matt, are you really serious about this?  I'll tell you why not to do it.  I
and neither of my colleagues have the expertise to do it.  We have such low
staff levels that there is no way we could provide this service 12 hours a
day never mind 24 hours.  Our middle grades are often locums with varying
degrees of experience and ability.  It's safer not to do it than to do it
from a clinical governance point of view.

I'm quite sure I could be trainned to do scans initially but I'm not sure
that there is enough scannable patholgy coming through the department for me
and my colleagues (and the fictional 24 hour middle grade cover) to maintain
our skills.  I know these are all old arguments but in some departments they
are genuine problems and blanket statements like yours do not help those of
us doing our best with the limited resources we have.  It almost marks us
out as some form of failing or second rate ED which I certainly don't
believe departments like ours are.  I'm  sure that couldn't have been your
intent but as you can see it can get backs up sometimes!

I am really pleased that some departments have the ability to push forward
the boundaries of Emergency Medicine, in various directions, and this is
vital to our specialty.  However, I feel that a distinct difference is
developing in the EM practised in well staffed, often central hospitals, and
the less well staffed, often district hospitals and it doesn't help if one
appears to think it is better than the other.  We have no intention of doing
RSI in our department (for the reasons outlined above) but we have an
excellent relationship with the anaesthetic department and immediate cover
as required.  This is a sensible and safe solution to our situation and
should be considered just as valid as ED led RSIs in other settings.  The
same could be said for various local solutions to chest pain, DVTs, PEs and
the like.  One size does not fit all and never will.  Sensible local
solutions with realistic, practical national guidance is the way forward.


Simon McCormick

P.S.  With regards to the case, if in doubt scan (especially at that
gestation), but in the absence of any significant examination findings and a
reasonable diferential diagnosis a next day scan could be considered
reasonable.


----- Original Message -----
From: "Dunn Matthew Dr. (RJC) A & E - SwarkHosp-TR"
<[log in to unmask]>
To: "Simon Mccormick" <[log in to unmask]>
Sent: Friday, August 27, 2004 9:10 AM
Subject: Re: UTI's, abdo pain and early pregnancy


> I'm afraid that I'd reckon that a woman with early pregnancy presenting to
> an ED with abdominal pain needs an ultrasound (and if she's having
> infertility treatment I might still worry even if I saw an intrauterine
> pregnancy). I accept that things are moving pretty slowly at present, but
at
> 6- 7 weeks there's a fair chance that an intrauterine pregnancy would be
> visible even with transabdominal ultrasound and a low level of expertise
> (with referral for negative or equivocal results). This is another reason
> why it is pretty difficult to defend running an ED without a scanner these
> days. Ultrasound is cheap and safe. Why not do it? Having said that,
that's
> my view on what ought to be done/ policy. In practice it is entirely
> possible that I'd look at the patient and think that all things considered
a
> scan wasn't needed.
>
> > I think we can assume that hcg was positive as the original
> > post said 6-7 weeks pregnant (in a fairly "confident" sort of
> > way!). And as far as I'm aware a negative hcg does rule out
> > ectopic, or at least rules out an ectopic that's going to
> > cause any problems.
>
>
> I thought it was the other way round: negative HCG rules out healthy
> pregnancy, but ruptured ectopics can be found with low levels of HCG.
>
> >  Urine or blood BhCG result? Although that wouldn't rule out
> > ectopic, it
> > would provide evidence that there is / isn't a pregnancy.
>
> As above, if you have a patient who has had a positive pregnancy test (or
> who you otherwise think is pregnant), but a negative HCG, that points
> towards ruptured ectopic.
>
> Matt Dunn
> Warwick.
>
>
>
> This email has been scanned for viruses by NAI AVD however we are unable
to
> accept responsibility for any damage caused by the contents.
> The opinions expressed in this email represent the views of the sender,
not
> South Warwickshire General Hospitals NHS Trust unless explicitly stated.
> If you have received this email in error, please notify the sender.
>