Clinical Sonography A Practical Guide, By Roger C. Sanders with the sonographers of the Johns Hopkins Hospital, Boston, Little, Brown and co., Book. Review_______________________. Clinical. Sonography: A Practical. Guide. 2nd ed. Edited by Roger C. Sanders,. MA, BM, BCh, MRCP, FRCR. Boston. Online PDF Clinical Sonography: A Practical Guide, Read PDF Clinical Practical Guide, pdf Sanders Clinical Sonography: A Practical Guide, the book Clinical.
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Clinical Sonography: A Practical Guide (Clinical Sonography: A Practical Guide ( Sanders)): Medicine & Health Science Books. Considered by many to be the most relied-upon, practical text of its kind, Clinical Sonography: A Practical Guide is appreciated for its clear, concise writing. Uniquely organized by symptom rather than organ or pathology, Roger Sanders\ us Clinical Sonography, 5e, not only ensures mastery of the content and.
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Patients with symptoms suggestive of turned to the probe, which converts returning sound cardiac, gynecologic, biliary tract, and abdominal vascular dis- into electrical impulses that are transformed into a ease periodically underwent ED sonography.
The initial interpre- tation was used as a diagnostic adjunct to subsequent therapy. Real-time sonography allows one The accuracy of positive sonographic findings was assessed by to identify motion in anatomical structures by contin- confirmatory testing, formal review, or confirmatory clinical uously updating the visual image projected onto the course. Emergency physicians were able to diagnose correctly 1 screen. Our hypothesis is that emergency physicians, presence of gallstones in patients with suspected biliary tract with a moderate amount of training, can reliably per- disease, and 6 the presence and size of abdominal aortic an- eurysms in patients with pulsatile masses or unexplained abdom- form sonography which influences the diagnosis and inal pain.
It was concluded that reliable sonography which influ- treatment of selected disorders. In this preliminary ences diagnosis and therapy can be performed by emergency study, we examined our initial experience with emer- physicians and that sonography should become a standard pro- gency department ED sonography and evaluated the cedure in EDs.
METHODS Ultrasonography is a relatively new diagnostic pro- In this retrospective study, our attending staff and cedure that uses high-frequency sound waves to ex- senior residents acquired a moderate level of expertise amine the structure and function of internal organs.
Real-time oscillating transducers with a me- cember 1, The accuracy of positive ED sonographic findings Key Words: was assessed by confirmatory testing computed to- 0 by W.
Saunders Company. In pregnant patients, anechoic structures pregnancy within the uterus, with characteristic highly echogenic Locate IUD when not seen on pelvic examination borders, were diagnosed as gestational sacs. Comprehensive follow-up for negative biliary tract, abdominal vascular, and cardiac effusions Wary Tract studies was not available. True-positives, false- positives, true-negatives, and false-negatives are re- Patients with symptoms suggestive of biliary tract ported.
The transducer was placed in the Cardiac RUQ, and imaging thru the right lower rib spaces was The cardiac applications extended to two sets of pa- performed as needed.
Views were obtained in the su- tients, those with suspected pericardial effusions and pine and decubitus positions with deep inspiration. Patients with jugular venous Additional imaging in the erect and belly-out positions distension, unexplained hypotension, pulsus paradox, was performed when supplemental views were re- enlarged cardiac silhouette, or electrical alternans quired.
No patient preparation was possible, thus if were suspected to have pericardial effusions. Clinical the gall bladder was inadequately visualized the study EMD was defined as narrow electrical complexes was repeated after several hours of fasting. All pa- without measurable BP or clinical evidence of perfu- tients with positive findings on ED sonography gall- sion. The transducer was usually placed in the stones or sludge had corroborative follow-up.
Imaging gallstones. Large the accuracy of our negative biliary tract studies. Transverse scans in 1 to 2-cm Gynecologic steps to 3 cm below the umbilicus were followed by Patients in early pregnancy with pelvic pain or vag- longitudinal scans.
Aneurysm was defined as an aorta inal bleeding underwent ED sonography. Large pericardial effusion, demonstrating large an- ble 2. Cardiac Gynecologic Three large clinically significant pericardial effu- Twenty of 40 pregnant patients studied in the ED sions were demonstrated by ED sonography. One pa- demonstrated intrauterine pregnancies with good fetal tient with cardiac tamponade, one with staphylococcal cardiac activity Fig 2.
Fifteen patients demonstrated pericarditis Fig l , and one postoperative intraperi- intrauterine gestation without visible fetal heart activ- cardial hemorrhage were identified. Ultrasonography ity Fig 3. In five patients no gestational sac could be was used to guide emergent needle pericardiocentesis demonstrated.
The presence of an intrauterine gesta- of two of the large pericardial effusions one by an tion was confirmed in all 15 patients with gestational emergency physician and one by a cardiologist. In sacs without cardiac activity. Of the five patients with- addition, four small- to moderate-sized nontraumatic out demonstrable gestational sacs on ED sonography pericardial effusions were identified that were fol- Fig 4 , one had an ectopic pregnancy, two had missed lowed conservatively.
One patient with a stab wound abortions, one had an early intrauterine pregnancy to the anterior portion of the chest underwent cardiac imaging.
No pericardial fluid was demonstrated by the initial ED sonogram or the formal study that followed. One of three patients in clinical EMD demonstrated good cardiac contractility without significant effu- sion on ED sonography; thus, resuscitation was con- tinued, with return of spontaneous pulses and respira- tions.
No further pulses or respiration were achieved in those patients with poorly organized or absent car- diac activity.
TABLE 2. Intrauterine pregnancy with a large fetal pole and fetal available. Volume 7, Number 6??