.att_us_sign
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BEGIN ATTENDING DOCUMENTATION
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Ultrasound Supervision Note
I was present for the resident ultrasound and personally reviewed the images in real time.
The images are available upon request in for review.
Electronically signed by
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END ATTENDING DOCUMENTATION
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.us_aorta
LIMITED BEDSIDE AORTIC ULTRASOUND
Indication: Evaluation for _
Proximal Aorta: _ cm
Distal Aorta: _ cm
Iliac arteries: _ cm bilateral
Interpretation: _
Performed by: _
.us_biliary
Limited Bedside Biliary Ultrasound
Indication: Evaluation for _
Gallstones: _
Gallbladder distention: _
Gallbladder wall measurement: _ cm (normal less than 0.35cm)
Common bile duct confirmed with color flow measured: _ cm (normal less than 0.70cm)
Sonographic Murphy’s sign: _
Interpretation: _
Performed by: _
.us_cardiac
Limited Bedside Cardiac Ultrasound
Indication: Evaluation of _
Cardiac Activity: _
Pericardial Effusion: _
Right Ventricular Dilation: _
LV Function: _
Interpretation: _
Performed by: _
.us_DVT
Limited Bedside Ultrasound Lower Extremity Venous Exam
Indication: Evaluation for _
RIGHT:
Common Femoral Vein: _ (patent and compressible / non-compressible)
Superficial Femoral Vein: _
Greater Saphenous Vein: _
Popliteal Vein: _
LEFT:
Common Femoral Vein: _ (patent and compressible / non-compressible)
Superficial Femoral Vein: _
Greater Saphenous Vein: _
Popliteal Vein: _
Interpretation: _
Performed by: _
.us_EFAST
Extended Focused Assessment with Ultrasonography in Trauma
Indication: Evaluation for _
Limited Bedside Cardiac Ultrasound
Cardiac view: Subcostal
Cardiac Activity: Present
Pericardial Effusion: _
Limited Abdomen Bedside Ultrasound
Hepatorenal interface: _
Splenorenal interface: _
Pericolic gutter: _
Limited Bedside Thoracic Ultrasound
LEFT THORAX
Left Pneumothorax: _ (as determined by the presence of sliding lung)
Left Pleural Effusion: _
RIGHT THORAX
Right Pneumothorax: _ (as determined by the presence of sliding lung)
Right Pleural Effusion: _
Interpretation: _
Performed by: _
.us_tvgyn
LIMITED BEDSIDE TRANSVAGINAL GYN ULTRASOUND NOTE
Indication: Evaluation of _
Right ovary: _ (visualized and has normal appearance with normal color flow)
Left ovary: _ (visualized and has normal appearance with normal color flow)
Uterus: _ (visualized in coronal and sagittal plane and appears normal)
Free fluid: _
Interpretation: _
Performed by: _
.us_tagyn
LIMITED BEDSIDE TRANSABDOMINAL GYN ULTRASOUND NOTE
Indication: Evaluation of _
Right ovary: _ (visualized and has normal appearance with normal color flow)
Left ovary: _ (visualized and has normal appearance with normal color flow)
Uterus: _ (visualized in coronal and sagittal plane and appears normal)
Free fluid: _
Interpretation: _
Performed by: _
.us_tvob
LIMITED BEDSIDE TRANSVAGINAL OB ULTRASOUND NOTE
Indication: Evaluation of _
Right ovary: _ (visualized and has normal appearance with normal color flow)
Left ovary: _ (visualized and has normal appearance with normal color flow)
Uterus: _ (visualized in coronal and sagittal plane and gestational sac with yolk sac and
FHR noted)
Free fluid: _
Interpretation: _
Performed by: _
.us_taob
LIMITED BEDSIDE TRANSABDOMINAL OB ULTRASOUND NOTE
Indication: Evaluation of _
Right ovary: _ (visualized and has normal appearance with normal color flow)
Left ovary: _ (visualized and has normal appearance with normal color flow)
Uterus: _ (visualized in coronal and sagittal plane and gestational sac with yolk sac and
FHR noted)
Free fluid: _
Interpretation: _
Performed by: _
.us_ocular
Limited Bedside Ocular Ultrasound
Indication: Evaluation of _
Eye: _ (RIGHT LEFT)
Lens intact: _
PVD Noted: _
PRD Noted: _
Optic Sheath Diameter: _ mm (normal less than 5mm)
CRA flow noted: _
Interpretation: _
Performed by: _
.us_renal
Limited Bedside Renal Ultrasound
Indication: Evaluation for _
RIGHT:
Hydronephrosis: _
Intra-renal stone: _
Other: _
LEFT:
Hydronephrosis: _
Intra-renal stone: _
Other: _
Bladder: _
Interpretation: _
Performed by: _
.us_softtissue
Limited Bedside Ultrasound of Soft Tissue
Indication: Evaluation of _
Location: _
Cobblestoning or signs of cellulitis noted: _ (Yes / No)
Fluid collection consistent with abscess formation noted: _
Foreign Body: _
Interpretation: _
Performed by: _
.us_testicle
Limited Bedside Testicle and Scrotum Ultrasound
Indication: Evaluation of _
Right testicle: _ (visualized and has normal appearance with normal venous and arterial
color flow)
Left testicle: _
Scrotum: _
Other: _
Interpretation: _
Performed by: _
.us_thorax
Limited Bedside Thoracic Ultrasound
Indication: Evaluation of _
LEFT THORAX
Left Pleural Effusion: _
Left interstitial Fluid: _ (as determined by less 3 B-lines / intercostal space)
Left Pneumothorax: _ (as determined by the presence of sliding lung)
Other: _
RIGHT THORAX
Right Pleural Effusion: _
Right interstitial Fluid: _ (as determined by less 3 B-lines / intercostal space)
Right Pneumothorax: _ (as determined by the presence of sliding lung)
Other: _
Interpretation: _
Performed by: _
Edit 9/22/14