Day 3: ISUOG trainee saves first life with ultrasound

After a long and fruitful first day, the KSUOG trainers very kindly took the whole team as well as our friends from NCMCH out for dinner at a local Korean restaurant prior to Prof Jun’s return to Seoul. Thank you KSUOG and Prof Jun for a delicious and wonderful evening! What a great way to start what is shaping up to be a truly inspiring outreach course.

Prof Kwang Jun Kim and trainees

Tuesday and Wednesday saw the ISUOG trainees continuing to advance through lectures and hands-on training, and the trainers continue to be very happy with the progress made.

Prof Moon-Young Kim demonstrates a scan

Today was a day full of particularly interesting cases that demonstrated almost word-for-word what had been taught in the classroom.

Dr Jeanty tells us more about today’s truly exciting developments:

Wow, this is a good one !
Classroom instruction:
1) we are teaching you ultrasound during this course, but do not forget that you are first and foremost clinicians.
2) although we are teaching you ultrasound in Ob-Gyn, remember that, if needed you can look at other things too with ultrasound, and it is good to have a little knowledge of non-ob-gyn ultrasound too.

Philippe observes a trainee scanning

Workshop in the afternoon: (Translated from Mongolian for the reader’s comfort :))

“What is the history of the patient you are going to scan?”
“2 C-sections.”
“Why is her doctor asking for a scan?”
“Want to learn where her placenta is”
“What should you think in a patient that had previous C-section?”
… silence…
… more prodding…
“Placenta previa?”
“OK, C-section and placenta previa… what should you be looking for?”
… more silence… more prodding…
“Placenta accreta?”
“Great, now you can scan!”

Mike Kammermeier provides some tips

First image on the lower uterine segment (37 weeks): textbook accreta-increta!!

Wow, the students were really eager to ask about the clinical history and indications for the next patients, and for sure they will forever remember this case!

Two patients later…

“Pelvic pain, normal physical exam”
First image on the screen: a gigantic cystic collection (15 by 12 by 7cm). Normal uterus, adnexa not seen.
We bet: Bladder or Cystadenoma?
“How would you find out?”
“Let her pee…”
… rescan after peeing…
No more cyst, it was her bladder. (Where else in the world do women have such a full bladder and do not bitterly complain about it?)
“Anything abnormal in her pelvis? Any masses?”
… long search: nothing…
“What else can cause pain ?”
…long list of differential (this was a left-lower-quadrant pain, after more questions to the patient)
…”Ureteral stone?”
“How would you find?”
“Look at her kidney for hydronephrosis…”

… we look at her kidneys and she has an anomaly of migration of her left kidney, that is resting mid-distance between the renal fossa and the promontory…
“How can you know this is the source of her pain?”
….
“Gently press on her kidney and you will see…” and this was clearly what was causing the patient’s pain.

So the lessons, were, if you don’t find the answer to the clinical question, try more, look elsewhere. The scanning protocols are wonderful, but remain clinicians first.

Assessing a patient

The students are all very eager to learn, despite the language barrier, they show great interest and it is such a pleasure for me to see each one of them conquer one milestone after another. A very great bunch of young people who will very much benefit from their training and go on to be useful to their respective regions (some travelled 1000-1500 km to attend). One area still to work on: they seem convinced that if you “paint” the whole patient with gel first, the exam will be easier 🙂 and another issue, learn to rest their arm or wrist on the patient instead of putting the whole weight of their arm on the transducer. Nothing that descendants of Genghis Khan cannot conquer!

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4 responses to “Day 3: ISUOG trainee saves first life with ultrasound

  1. The title of this post is highly misleading and smacks of unnecessary sensationalism. I’m sure that neither ISUOG nor Dr Jeanty needs such blatant advertising. ISUOG is doing a wonderful job of propagating the correct of ultrasound. I absolutely agree with you that we are clinicians first and ultrasound should help in completing the picture already given in context of an individual patient. But i strongly feel that we should stick to the ethics of profession and not indulge in such ‘limelight-hogging’ kind of reporting.

    • Thanks for your input, @doktorobgyn. We understand your point and it was of course not our intention to be sensationalist. Perhaps the excitement of saving lives just got the better of us! Thank you for your support.

  2. correction line 4: ‘correct use of ultrasound’

  3. Michael Crade, MD

    To Dr. Jeanty and your wonderful team,
    Greatly appreciate the presentation, your enthusiasm, energy and efforts.

    MC

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