A 65+ year old male with BPH had an abdominal surgery earlier that day. After each of his last 3 surgeries he had developed urinary retention and went home with a Foley. This time, he was sent home from the PACU without a Foley. He presented to the ED with what looked like a soccer ball under his t-shirt. He had not urinated since the operation.
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The week before, I watched a lecture by the ultrasound director at UC Irvine, Dr. Christian Fox. It was directed toward medical students, but I am a novice at ultrasonography, so it was perfect for me. Dr. Fox said the bladder is like a box - so 3 dimensional measurements of W x Lx H will give you a pretty accurate reading. He also told me that a bladder shouldn't hold much more than 1/2 L, so when I measured out 0.9 L, I was concerned.
I took out my Genius Scan app on my iPad, and snapped a picture of the bladder on the ultrasound screen, complete with measurements, and saved it to Evernote.
"Are you seriously calling me to place a Foley?" he said. "Tell surgery to do it."
- They already tried
"So get a senior to do it,"
- He already tried
"Why couldn't you get it in?"
- That's why I'm calling you. I need you to tell me.
"Are you sure there's even urine in his bladder?
- Check your email
- Check your email; I sent you a picture of his bladder with 900 cc of urine in it
"It's 2 AM!"
- The dashboard says you are on call
- Oh, good, I'll see you in a few,