Bedside Ultrasound Reports 1 of 2 (DRAFT)

Performed by: [text size="40"]
Interpreted by: [text size="40"]
[checkbox memo="Supervising Physician" name="ussup" value="" memo_color="lightgreen"][conditional field="ussup" condition="(ussup).is('')"]Supervised by: [text size="20"][/conditional]
Chaperoned by: [conditional field="procchapdecl" condition="(procchapdecl).isNot('declined')"][text size="40"][/conditional][checkbox name="procchapdecl" value="Patient declined"]

Consent: [select name="abdmiscconsent_1" value="Verbal|Written|Not obtained"]
Exam Performed:[select name="abdminconsent_2" value="Complete|Limited"]

[checkbox name="aorta" value="Abdominal Aorta Ultrasound Report"][conditional field="aorta" condition="(aorta).is('Abdominal Aorta Ultrasound Report')"](Limited exam)[comment memo="CPT Code: 76775 Modifier:26" memo_size="small" memo_color="peachpuff"]

**INDICATIONS** 

A focused ultrasound exam of the aorta was performed to evaluate for abdominal aortic aneurysm (AAA). The ultrasound was performed for the following indications: [checkbox name="aortaIN" value="Abdominal pain|Back pain|Chest pain|Pulsatile abdominal mass|Unexplained hypotension|Syncope|Flank pain|Groin pain|Other risk factors for AAA as noted in the original note"]

**IDENTIFIED STRUCTURES**[comment memo="
ALWAYS use the liver and spleen as windows when possible" memo_size="small" memo_color="peachpuff"][comment memo="
Finding the aorta on a large body habitus can be difficult. Start out by having the patient relax their abdominal wall (as much as possible). Then with a curvilinear probe, place the transducer directly inferiorly to the xiphoid process. If gas (seen as dirty shadowing) interferes with your ability to visualize deeper structures, apply constant light pressure with the transducer and slowly slide the probe in the direction of the descending aorta to help displace overlying gas. Remember, the aorta is initially located deep as it enters the peritoneal cavity and starts to be come more shallow as it descends towards the pelvis." memo_size="small" memo_color="lightyellow"][comment memo="
Too much pressure will change the shape of the aorta and affect diameter measurements." memo_size="small" memo_color="pink"]

Multiple real-time sonographic images were obtained of the abdominal aorta from the diaphragmatic hiatus to the aortic bifurcation using a [select name="aortaTrans" value="curvilinear|linear|phased array"] transducer in both the transverse and longitudinal views.[/conditional][conditional field="aorta|aortasup_1" condition="(aorta).is('Abdominal Aorta Ultrasound Report')"]
[checkbox memo="Additional structures include:" name="aortasup_1" value="" memo_color="lightgreen"][/conditional][conditional field="aorta|aorta_1" condition="(aortasup_1).is('')"]
Additional structures include: [checkbox name="aortastructures" value="Pancreas|Stomach|Spleen|Left hepatic lobe|IVC|Celiac axis|SMA|Left renal artery|Right renal artery|Left renal vein|Right renal vein"] [/conditional][conditional field="aorta" condition="(aorta).is('Abdominal Aorta Ultrasound Report')"]
**FINDINGS** [comment memo="
According to Ma and Mateer's Emergency Medicine Ultrasound Edition 3, point-of-care aortic ultrasound can achieve 100% accuracy for identification of AAA with brief training of the operator." memo_size="small" memo_color="lightyellow"][comment memo="
Approximately 90% of AAA are located infrarenal. Upper limits of normal for aortic diameter is as follows: 2.7cm at diaphragm, 2.0cm in mid-abdomen, and 1.8cm at bifurcation, per the Hertzberg and Middleton of Ultrasound: The Requisites (Third Edition)." memo_size="small" memo_color="peachpuff"] 

Exam of the above structures revealed the following: [comment memo="
Measure AP diameter on longitudinal views to avoid overestimation from not being perpendicular to the long axis of the aorta. AND measure from OUTER wall to OUTER wall" memo_size="small" memo_color="pink"] [comment memo="
Keep in mind, mural thrombus is common with large AAA. If you do not see a thrombus but instead see internal septations, that may be a dissection" memo_size="small" memo_color="lightyellow"] 

[checkbox name="aortaFind" value="Aorta|Unable to view aorta due to technically difficult exam|Free fluid within the peritoneal cavity"][/conditional][conditional field="aorta|aortaFind" condition="((aorta).is('Abdominal Aorta Ultrasound Report'))&&((aortaFind).is('Aorta'))"]

- The proximal aorta was [select name="proxaorta_1" value="visualized|not visualized"].[/conditional][conditional field="aorta|aortaFind|proxaorta_1" condition="((aorta).is('Abdominal Aorta Ultrasound Report'))&&((aortaFind).is('Aorta'))&&((proxaorta_1).is('visualized'))"] Maximum diameter from outer wall to outer wall was measured to be [text size="20"] cm.[/conditional][conditional field="aorta|aortaFind|proxaorta_1" condition="((aorta).is('Abdominal Aorta Ultrasound Report'))&&((aortaFind).is('Aorta'))"]
- The distal aorta was [select name="distaorta_1" value="visualized|not visualized"].[/conditional][conditional field="aorta|aortaFind|distaorta_1" condition="((aorta).is('Abdominal Aorta Ultrasound Report'))&&((aortaFind).is('Aorta'))&&((distaorta_1).is('visualized'))"] Maximum diameter from outer wall to outer wall was measured to be [text size="20"] cm.[/conditional][conditional field="aorta|aortaFind|proxaorta_1" condition="((aorta).is('Abdominal Aorta Ultrasound Report'))&&((aortaFind).is('Aorta'))"]
- Tapering of the aorta was noted to be [select name="aortatap_1" value="normal|abnormal"].

Abdominal Aortic Aneurysm was [select name="AAAFind_1" value="identified|not identified"][/conditional][conditional field="aorta|aortaFind|AAAFind_1" condition="((aorta).is('Abdominal Aorta Ultrasound Report'))&&((aortaFind).is('Aorta'))&&((AAAFind_1).is('identified'))"]. Found to be located [select name="AAAID_1" value="infrarenal|suprarenal|in both infrarenal and suprarenal regions"].[/conditional][conditional field="aorta|aortaFind" condition="((aorta).is('Abdominal Aorta Ultrasound Report'))&&((aortaFind).is('Free fluid within the peritoneal cavity'))"] 

Quantity of fluid: [comment memo="
To determine fluid quantity, look at how much is surrounding an identified structure. If bowel is floating in anechoic fluid, quantity would be considered LARGE. If there is a thin layer of anechoic space that does NOT surround an identified structure then quantity would be small. Anything else inbetween is considered moderate" memo_size="small" memo_color="lightyellow"][checkbox name="Abdaorta_6" value="Small|Moderate|Large"][/conditional][conditional field="aorta" condition="(aorta).is('Abdominal Aorta Ultrasound Report')"]

**INTERPRETATION** [comment memo="
Primary diagnostic criteria for AAA is an aortic diameter greater than 3cm. Clinically significant AAA is one that measures 5cm or more. Intervention should be considered when the diameter is 5-5.5cm due to high risk of rupture over next 8 years being around 25%, per Hertzberg and Middleton of Ultrasound:Requisites (Third Edition)" memo_size="small" memo_color="lightyellow"] [textarea cols=80 rows=10]

DISCLAIMER: Discussed with patient the limitations of this ultrasound to include its inability to completely rule out aortic dissection or thoracic aortic aneurysm.[/conditional][checkbox name="abdmisc" value="Abdominal Miscellaneous Report"][conditional field="abdmisc" condition="(abdmisc).is('Abdominal Miscellaneous Report')"][comment memo="CPT Code: 76705 Modifier:26" memo_size="small" memo_color="peachpuff"]

**INDICATIONS**

A focused ultrasound exam of the abdomen was performed for the following indications: [checkbox name="abdmiscIN" value="RUQ pain|RLQ pain|LUQ pain|LLQ pain|Abdominal mass|Abdominal wall distension|Palpation of an abdominal mass|PO intolerance"]

**INTERPRETATION** [textarea cols=80 rows=10]

DISCLAIMER: Discussed with patient the limitations of this ultrasound to include its inability to completely rule out appendicitis, intestinal perforation, presence or abscess of an intraabdominal abscess, small bowel obstruction, retroperitoneal pathology, colitis, presence or absence of a foreign body within the abdomen, arteriovenous malformations, intraabdominal tumors, or ileus.[/conditional][checkbox name="appendix" value="Appendix Ultrasound Report"][conditional field="appendix" condition="(appendix).is('Appendix Ultrasound Report')"][comment memo="CPT Code: 76705 Modifier:26" memo_size="small" memo_color="peachpuff"]

**INDICATIONS** 

A focused ultrasound exam of the right lower abdominal quadrant was performed to evaluate for appendicitis. The ultrasound was performed for the following indications: [checkbox name="appendixIN" value="Abdominal pain|Nausea/vomiting|Fever|Other indications as noted in the original note"]

**IDENTIFIED STRUCTURES**[comment memo="
Graded compression applied to the abdomen in the area of maximal tenderness is accomplished by applying firm pressure directed posteriorly on a supine patient 1cm of depth at a time. The purpose is to gradually bring the abdominal wall in contact with the psoas muscle. This may be difficult on a large body habitus" memo_size="small" memo_color="lightyellow"]

Multiple real-time sonographic images were obtained of the right lower abdominal quadrant using a [select name="appendixTrans" value="curvilinear|linear"] transducer and graded compression technique. Images per obtained within the transverse and sagittal planes.[/conditional][conditional field="appendix|ussup_1" condition="(appendix).is('Appendix Ultrasound Report')"]
[checkbox memo="Additional structures include:" name="ussup_1" value="" memo_color="lightgreen"][/conditional][conditional field="appendix|ussup_1" condition="(ussup_1).is('')"]
Additional structures include: [checkbox name="appendixstructures" value="Right psoas muscle|Right iliac vessels|Cecum/Terminal ileum"] [/conditional][conditional field="appendix" condition="(appendix).is('Appendix Ultrasound Report')"]

**FINDINGS** [comment memo="
Sensitivity and specificity of graded compression sonography in experienced hands were reported to be 76-90% and 90-98%, respectively, per Ma and Matter's Emergency Medicine Ultrasound Edition 3. According to the Hertzberg and Middleton of Ultrasound: The Requisites (Third Edition), the sensitivity and specificity is approx 80%" memo_size="small" memo_color="lightyellow"]

Exam of the above structures revealed the following: [comment memo="
Correct identification of the appendix is crucial. Sometimes differentiating loops of the ileum from the appendix can be difficult. The appendix should be noncompressible, without peristalsis, and have a blind end." memo_size="small" memo_color="lightyellow"] 

[checkbox name="appendixFind" value="Right psoas muscle|Right iliac vessels|Unable to visualize appendix due to technically difficult exam|Appendix|Free fluid within the peritoneal cavity"][/conditional][conditional field="appendix|appendixFind" condition="((appendix).is('Appendix Ultrasound Report'))&&((appendixFind).is('Appendix'))"]

A tubular structure was identified and found to be [select name="Appendix_1" value="dilated at least 6mm in diameter|less than 6mm in diameter"], [select name="Appendix_2" value="non-compressible|compressible"],[select name="Appendix_3" value="without peristalsis|with peristalsis"], [select name="Appendix_4" value="included a blind end|(unable to visualize blind end)"], and was [select name="Appendix_5" value="found to be hyperemic|not found to be hyperemic"].[/conditional][conditional field="appendix|appendixFind" condition="((appendix).is('Appendix Ultrasound Report'))&&((appendixFind).is('Free fluid within the peritoneal cavity'))"]

Quantity of fluid: [comment memo="
To determine fluid quantity, look at how much is surrounding an identified structure. If bowel is floating in anechoic fluid, quantity would be considered LARGE. If there is a thin layer of anechoic space that does NOT surround an identified structure then quantity would be small. Anything else inbetween is considered moderate" memo_size="small" memo_color="lightyellow"][checkbox name="Appendix_6" value="Small|Moderate|Large"]
[/conditional][conditional field="appendix" condition="(appendix).is('Appendix Ultrasound Report')"]

**INTERPRETATION** [comment memo="
Primary diagnostic criteria for appendicitis is an appendiceal diameter greater than 6mm" memo_size="small" memo_color="lightyellow"] [textarea cols=80 rows=10]

DISCLAIMER: Discussed with patient the limitations of this ultrasound to include its inability to completely rule out appendicitis, intestinal perforation, presence or abscess of an intraabdominal abscess, intraabdominal tumors, or ileus.[/conditional][checkbox name="bladder" value="Bladder Scan Ultrasound Report"][conditional field="bladder" condition="(bladder).is('Bladder Scan Ultrasound Report')"][comment memo="CPT Code: 76857 Modifier:26" memo_size="small" memo_color="peachpuff"]

**INDICATIONS** 

A focused ultrasound exam of the urinary bladder was performed to evaluate for urinary retention. The ultrasound was performed for the following indications: [checkbox name="bladderIN" value="Abdominal pain|Abdominal distension|Decreased urine output|Other indications as noted in the original note"]

**IDENTIFIED STRUCTURES**[comment memo="
To find the bladder and get accurate measurements, place curvilinear transducer superior to the pubic symphysis and aim probe caudally" memo_size="small" memo_color="lightyellow"]

Multiple real-time sonographic images were obtained of the bladder using a [select name="bladderTrans" value="curvilinear|linear"] transducer in both the transverse and sagittal planes.[/conditional][conditional field="bladder|bladdersup_1" condition="(bladder).is('Bladder Scan Ultrasound Report')"]
[checkbox memo="Additional structures include:" name="bladdersup_1" value="" memo_color="lightgreen"][/conditional][conditional field="bladder|bladdersup_1" condition="(bladdersup_1).is('')"]
Additional structures include: [checkbox name="bladderstructures" value="Iliac vessels|Uterus|Prostate|Right ovary|Left ovary|Rectum"][/conditional][conditional field="bladder" condition="(bladder).is('Bladder Scan Ultrasound Report')"]

**FINDINGS** [comment memo="For bladder wall thickness, upper limits of normal are 3 mm when bladder is well distended and 5 mm when it is poorly distended, per Ma and Matter's Emergency Medicine Ultrasound (Edition 3)" memo_size="small" memo_color="lightyellow"] 
  
Exam of the above structures revealed the following findings:  

- Bladder width: [text name="BW" size="20"] cm
- Bladder depth: [text name="BD" size="20"] cm
- Bladder height: [text name="BH" size="20"] cm
- Estimated volume: [calc value="(0.53*(BW)*(BD)*(BH))"][comment memo="Calculation will automatically display once you click 'Calculate Result' button at bottom of the page" memo_size="small" memo_color="pink"]cc
- Bladder liths were [select name="bladderFind_2" value="not present|present"].
- Bladder diverticula were [select name="bladderFind_3" value="not present|present"].
- Hyperemia of the bladder wall was [select name="bladderFind_3b" value="not assessed|present|not present"].
- Bladder wall thickness was [select name="bladderFind_4" value="not measured|measured"][/conditional][conditional field="bladder|bladderFind_4" condition="((bladder).is('Bladder Scan Ultrasound Report'))&&((bladderFind_4).is('measured'))"]
- Wall thickness: [text size="10"] mm[/conditional][conditional field="bladder" condition="(bladder).is('Bladder Scan Ultrasound Report')"]

**INTERPRETATION** [comment memo="In adults, less than 50cc of post void residual is considered adequate bladder emptying. Over 200cc indicated inadequate emptying. In children, more than 20cc of post void residual is considered abnormal. In elderly patients, 50-100cc post void residual is considered normal. Over 500cc of post void residual associated with other abnormal neurological findings appears to be highly predictive of cauda equina syndrome. Resource: Ballstaedt and Woodbury 'Bladder Post Void Residual Volume" published in StatPearls Jan2021'" memo_size="small" memo_color="lightyellow"] [textarea cols=80 rows=10]

DISCLAIMER: Discussed with patient the limitations of this ultrasound to include its inability to completely rule out cauda equina syndrome.[/conditional][checkbox name="DVT" value="DVT Ultrasound Report"][conditional field="DVT" condition="(DVT).is('DVT Ultrasound Report')"](Limited exam)[comment memo="CPT Code: 93971 Modifier:26" memo_size="small" memo_color="peachpuff"]

**INDICATIONS** 

Limited compression ultrasonography of [select name="DVTextremity_1" value="the right|the left|both the right and left"] lower extremity was performed to evaluate for non-compressibility of the common femoral vein (CFV), superficial femoral vein (SFV), and popliteal vein(PV) in the patient. The ultrasound was performed for the following indications: [checkbox name="DVTIN" value="Lower extremity pain|Lower extremity swelling|Chest Pain|Dyspnea|Tachypnea|Unexplained hypotension|Other risk factors for DVT as noted in the original note"]

**IDENTIFIED STRUCTURES**[comment memo="
Depending on the patient's body habitus, you will need to use either a linear or curvilinear probe. Start by placing probe within the crease between the groin and affected extremity. Look for the common femoral vein, common femoral artery, and greater saphenous vein. This should look like the 'whale sign'. Then travel the length of the common femoral vein down to the bifurcation of the superficial and deep femoral veins. (you will lose track of the deep femoral vein as it tranverses laterally). Continue distally following the superficial vein, being careful to look for a duplicate vein posteriorly. You may lose track of the superfical femoral vein as it travels through the adductor hiatus. If this happens, you can try to apply pressure with your non-scanning hand from the area of the leg directly across from the probe. Once you've mapped out the path of the femoral vein, go back and rescan the course while applying compression every 1cm. Also make sure to look at the popliteal fossa and assess the popliteal vein." memo_size="small" memo_color="lightyellow"]

Multiple real-time sonographic images were obtained from the proximal common femoral to the distal superficial femoral and popliteal veins using a [select name="DVTTrans" value="curvilinear|linear"] transducer in the transverse view.[/conditional][conditional field="DVT|DVTsup_1" condition="(DVT).is('DVT Ultrasound Report')"]
[checkbox memo="Additional structures include:" name="DVTsup_1" value="" memo_color="lightgreen"][/conditional][conditional field="DVT|DVT_1" condition="(DVTsup_1).is('')"]
Additional structures include: [checkbox name="DVTstructures" value="Lesser saphenous vein|Anterior tibial vein|Posterior tibial vein|Peroneal vein"] [/conditional][conditional field="DVT" condition="(DVT).is('DVT Ultrasound Report')"]

**FINDINGS** [comment memo="
According to Ma and Mateer's Emergency Medicine Ultrasound Edition 3, point-of-care DVT ultrasound can achieve 100% accuracy for identification of a DVT with brief training of the operator." memo_size="small" memo_color="lightyellow"]

Exam of the above structures revealed the following: [comment memo="
DVT diagnosed with evidence of a non-compressible vein anywhere along the path of the proximal common femoral to the popliteal vessel" memo_size="small" memo_color="pink"] 

[select name="DVTextremity_2" value="The right|The left|Both the right and left"] lower extremity [select name="DVTextremity_3" value="was|were"] assessed. [/conditional][conditional field="DVT|DVTextremity_2" condition="((DVT).is('DVT Ultrasound Report'))&&((DVTextremity_2).is('The right'))"]

- Right CFV found to be [select name="rCFV_1" value="compressible|non-compressible"].
- Right SFV found to be [select name="rSFV_1" value="compressible|non-compressible"].
- Right Popliteal vein found to be [select name="rPV_1" value="compressible|non-compressible"].[/conditional][conditional field="DVT|DVTextremity_2" condition="((DVT).is('DVT Ultrasound Report'))&&((DVTextremity_2).is('The left'))"]

- Left CFV found to be [select name="lCFV_1" value="compressible|non-compressible"].
- Left SFV found to be [select name="lSFV_1" value="compressible|non-compressible"].
- Left Popliteal vein found to be [select name="lPV_1" value="compressible|non-compressible"].[/conditional][conditional field="DVT|DVTextremity_2" condition="((DVT).is('DVT Ultrasound Report'))&&((DVTextremity_2).is('Both the right and left'))"] 

- Right CFV found to be [select name="rCFV_2" value="compressible|non-compressible"].
- Right SFV found to be [select name="rSFV_2" value="compressible|non-compressible"].
- Right Popliteal vein found to be [select name="rPV_2" value="compressible|non-compressible"].
- Left CFV found to be [select name="lCFV_2" value="compressible|non-compressible"].
- Left SFV found to be [select name="lSFV_2" value="compressible|non-compressible"].
- Left Popliteal vein found to be [select name="lPV_2" value="compressible|non-compressible"].

**INTERPRETATION**[comment memo="
Pro-tip: use of doppler can help look for abnormal flow through veins which may seem to compress partially but not completely" memo_size="small" memo_color="pink"]
[textarea cols=80 rows=10]

DISCLAIMER: Discussed with patient the limitations of this ultrasound to include its inability to completely rule out recurrence of a DVT if patient was recently diagnosed with a DVT of same affected extremity within the past 6 months and early formation of a DVT.[/conditional][checkbox name="variable_5" value="ECHO/Cardiac" value="ECHO/Cardiac Ultrasound Report"][checkbox name="eFAST" value="eFAST Ultrasound Report"][conditional field="eFAST" condition="(eFAST).is('eFAST Ultrasound Report')"](Limited exam)[comment memo="CPT Code: 76705, 93308, 76604 Modifier:26" memo_size="small" memo_color="peachpuff"]

**INDICATIONS** 

A focused ultrasound exam of the peritoneal space (including the following areas: sub-phrenic, Morison's pouch, splenorenal, superior colic gutters, and retro-vesicular), pericardial space, and pleural spaces was performed to evaluate for free fluid. The anterior lung fields were also evaluated to assess for lung sliding, and presence of fluid or air within the pleura. The ultrasound was performed for the following indications: [checkbox name="eFASTIN" value="Abdominal pain|Blunt abdominal trauma|Chest pain|Pulsatile abdominal mass|Penetrating abdominal trauma|Unexplained hypotension|Tachycardia|Dyspea|Other indications as noted in the original note"]

**IDENTIFIED STRUCTURES**[comment memo="
ALWAYS use the liver and spleen as windows when possible" memo_size="small" memo_color="peachpuff"][comment memo="
Start the exam off by assessing the right upper quadrant particularly paying attention to the Morrison's pouch, which is the most dependent portion for free fluid within the abdomen. Don't forget to look at the paracolic gutter or tip of the right hepatic lobe for free fluid. Once you scan this area, then proceed to the subxiphoid area to scan for the heart. This may be hard to do in a person with a large body habitus or acute abdominal pain since you will need to place a lot of pressure. If you choose to use the subxiphoid area, you will need to increase your scanning depth, and most importantly grip the transducer overhand while keeping the probe almost parallel to the skin of the abdomen. If this is not reasonable, you can always use the parasternal long (probe positioned within the second left intercostal space with the indicator aimed to the left hip) and parasternal short (probe positioned within the second left intercostal space with the indicator directed to the right hip) views to look at the heart. Pay close attention to the pleural and the pericardial spaces. Once this is complete, proceed to the left upper quadrant looking at the splenorenal recess and paracolic gutter. The fourth area you should scan is the pelvis. Place the probe directly superior to the pubic symphysis and aim towards the patient's feet. Make sure to carefully assess each of the recesses that are specific for women and men (i.e. Douglas pouch for women). Lastly, finish the exam by looking at the right and left anterior lung fields to assess for lung sliding and pleural effusion. You may want to use m-mode to look for the sand on the beach (normal) or barcode signs (possible pneumothorax)" memo_size="small" memo_color="lightyellow"] [comment memo="Fun fact, because of the splenorenal ligament, blood from a splenic laceration will flow from the LUQ straight to the RUQ and down into the right paracolic gutter into the pelvis." memo_size="small" memo_color="pink"]

Multiple real-time sonographic images were obtained of the heart, diaphragms, liver, spleen, kidneys, and bladder as well as the spaced noted above using a [select name="eFASTTrans" value="curvilinear|linear|phased array|curvilinear and phased array|curvilinear, phased array, and linear"] transducer.[/conditional][conditional field="eFAST|eFASTsup_1" condition="(eFAST).is('eFAST Ultrasound Report')"]
[checkbox memo="Additional structures include:" name="eFASTsup_1" value="" memo_color="lightgreen"][/conditional][conditional field="eFAST|eFAST_1" condition="(eFASTsup_1).is('')"]
Additional structures include: [checkbox name="eFASTstructures" value="Pancreas|Stomach|Spleen|IVC|Prostate|Left Ovary|Right Ovary|Uterus|Bladder"] [/conditional][conditional field="eFAST" condition="(eFAST).is('eFAST Ultrasound Report')"]
**FINDINGS** [comment memo="
According to Ma and Mateer's Emergency Medicine Ultrasound Edition 3, point-of-care aortic ultrasound can achieve high sensitivity and specificity for identification of free fluid within the thoracic and peritoneal cavities, however there exists some variation on accuracy which is largely operator dependent." memo_size="small" memo_color="lightyellow"]

Exam of the above structures and spaces revealed the following:

[checkbox name="eFASTFind" value="Absence of free fluid within the abdomen and thorax.|Free fluid in the following places listed below.|Absence of lung sliding in the left anterior lung field.|Absence of lung sliding in the right anterior lung field."][/conditional][conditional field="eFAST|eFASTFind" condition="((eFAST).is('eFAST Ultrasound Report'))&&((eFASTFind).is('Free fluid in the following places listed below.'))"]

- Morison's pouch:[select name="eFASTfluid_1" value="not visualized|visualized"]
- Splenorenal fossa: [select name="eFASTfluid_2" value="not visualized|visualized"]
- Retrovesicular space: [select name="eFASTfluid_3" value="not visualized|visualized"]
- Pericardia space: [select name="eFASTfluid_4" value="not visualized|visualized"]
- Evidence of pericardial tamponade: [select name="eFASTfluid_5" value="not visualized|visualized"] 
- Pleural space: [select name="eFASTfluid_6" value="not visualized|visualized"][/conditional][conditional field="eFAST" condition="(eFAST).is('eFAST Ultrasound Report')"]

**INTERPRETATION** [textarea cols=80 rows=10]

DISCLAIMER: Discussed with patient the limitations of this ultrasound to include its inability to completely rule out aortic dissection, thoracic aortic aneurysm, abdominal aortic aneurysm, retroperitoneal injury, injury of a solid organ, fluid from ascites versus blood, fluid from a penetrated bladder versus blood, fluid from heart failure versus blood, or fluid from other inflammatory or malignant disease versus blood.[/conditional][checkbox name="firsttrius" value="First Trimester Ultrasound Report"][conditional field="firsttrius" condition="(firsttrius).is('First Trimester Ultrasound Report')"]
(Limited for Dating) 

Method: [select name="method" memo="*" memo_size="small" memo_color="blue" value="TRANSVAGINAL|TRANSABDOMINAL"][/conditional][conditional field="firsttrius|method" condition="(firsttrius).is('First Trimester Ultrasound Report')&&(method).is('TRANSVAGINAL')"][comment memo="CPT Code - 76817" memo_size="small" memo_color="blue"][/conditional][conditional field="firsttrius|method" condition="(firsttrius).is('First Trimester Ultrasound Report')&&(method).is('TRANSABDOMINAL')"][comment memo="CPT Code - 76801" memo_size="small" memo_color="blue"][/conditional][conditional field="firsttrius" condition="(firsttrius).is('First Trimester Ultrasound Report')"]
Date of Ultrasound: [date name="dateus1" default="today"]
LMP: [date name="dateLMP"] 
Number of Fetuses: [select name="fetalcount" value="singleton|"][conditional field="fetalcount" condition="(fetalcount).is('')"][text size="20"][/conditional][conditional field="firsttrius" condition="(firsttrius).is('First Trimester Ultrasound Report')"]Cardiac Activity: [select name="FHR" value="FHR|present but indeterminant by M-mode|not present"][conditional field="FHR" condition="(FHR).is('FHR')"] [text size="4"] bpm, calculated via M-mode.
Maternal vital signs reviewed and found to be
[select name="maternalvitalsign_1" value="within normal limits|abnormal as discussed within the plan below"][/conditional][conditional field="firsttrius" condition="(firsttrius).is('First Trimester Ultrasound Report')"]

Assessments: [checkbox name="Measure" value="yolk sac visualized|fetal/embryonic pole visualized|crown-rump length assessed|mean sac diameter assessed"][/conditional][conditional field="Measure" condition="(Measure).is('crown-rump length assessed')"]

CRL Measurements:
CRL: [text name="CRL1" size="8"] cm
CRL: [text name="CRL2" size="8"] cm
CRL: [text name="CRL3" size="8"] cm

Mean CRL: [/conditional][conditional field="Measure|meanCRLcalc" condition="((meanCRLcalc).isNot(''))&&((Measure).is('crown-rump length assessed'))"][text name="CRL3" size="8"] cm [/conditional][conditional field="Measure" condition="(Measure).is('crown-rump length assessed')"][checkbox name="meanCRLcalc" memo="click for calculated value" memo_size="small" memo_color="yellow" value=""][/conditional][conditional field="meanCRLcalc" condition="(meanCRLcalc).is('')"]
[calc value="score1=(CRL1)/3+(CRL2)/3+(CRL3)/3" memo="calc'd mean CRL"] cm
EGA by CRL: [calc value="score2=(CRL1)/3+(CRL2)/3+(CRL3)/3;score2>6.6?'cannot calculate':score2>6.449?'12w5d':score2>6.249?'12w4d':score2>6.049?'12w3d':score2>5.849?'12w2d':score2>5.649?'12w1d':score2>5.549?'12w0d':score2>5.349?'11w6d':score2>5.149?'11w5d':score2>4.949?'11w4d':score2>4.749?'11w3d':score2>4.649?'11w2d':score2>4.449?'11w1d':score2>4.249?'11w0d':score2>4.149?'10w6d':score2>3.949?'10w5d':score2>3.849?'10w4d':score2>3.649?'10w3d':score2>3.549?'10w2d':score2>3.349?'10w1d':score2>3.249?'10w0d':score2>3.049?'9w6d':score2>2.949?'9w5d':score2>2.849?'9w4d':score2>2.649?'9w3d':score2>2.549?'9w2d':score2>2.449?'9w1d':score2>2.349?'9w0d':score2>2.149?'8w6d':score2>2.049?'8w5d':score2>1.949?'8w4d':score2>1.849?'8w3d':score2>1.749?'8w2d':score2>1.649?'8w1d':score2>1.549?'8w0d':score2>1.449?'7w6d':score2>1.349?'7w5d':score2>1.249?'7w4d':score2>1.149?'7w3d':score2>1.049?'7w1d':score2>0.999?'7w0d':'cannot calculate'" memo="calc'd EGA"] 
[comment memo="EGA calculation based on Robinson CRL Curve referenced in Robinson HP. Sonar measurements of fetal crown-rump length as means of assessing maturity in first trimester of pregnancy. Br Med J 1973;4:28-31" memo_size="small"]
[/conditional][conditional field="Measure" condition="(Measure).is('mean sac diameter assessed')"]
Gestation Sac Measurements:
Sac Measurement#1: [text name="GSD1" size="8"] cm
Sac Measurement#2: [text name="GSD2" size="8"] cm
Sac Measurement#3: [text name="GSD3" size="8"] cm
Mean Sac Diameter: [calc value="score1=(GSD1)/3+(GSD2)/3+(GSD3)/3" memo="calc'd mean GSD"] cm[/conditional][conditional field="Measure" condition="(Measure).is('crown-rump length assessed')||(Measure).is('mean sac diameter assessed')"]
EGA by LMP: [text name="EGALMPw" size="5"]w [text name="EGALMPd" size="3"]d
EGA by U/S: [text name="EGAUSw" size="5"]w [text name="EGAUSd" size="3"]d[/conditional][conditional field="firsttrius" condition="(firsttrius).is('First Trimester Ultrasound Report')"]

Interpretation:

Patient is a [text name="maternalage_1" default="age" size="8"] year old G[text name="gravida_1" default="gestation" size="8"]P[text name="para_1" default="para"] here for first trimester US dating.

-[select name="Interpretation" value="Intrauterine Pregnancy|Viability of pregnancy indeterminant|Possible embryonic demise"][conditional field="Interpretation|EDCdetermine" condition="((Interpretation).is('Intrauterine Pregnancy'))&&((EDCdetermine).is('LMP confirmed by 1st tri U/S'))"] at [var name="EGALMPw"]+[var name="EGALMPd"] wks
-EDD is [calc memo="final EDD" value="score1=(dateLMP).dateAdd(280)"][/conditional][conditional field="Interpretation|EDCdetermine" condition="((Interpretation).is('Intrauterine Pregnancy'))&&((EDCdetermine).is('1st tri U/S'))"] at [var name="EGAUSw"]+[var name="EGAUSd"] wks
-EDD is [date name="1sttriusEDD"][/conditional] [conditional field="Interpretation" condition="(Interpretation).is('Intrauterine Pregnancy')"][/conditional][conditional field="firsttrius" condition="(firsttrius).is('First Trimester Ultrasound Report')"]based on [select name="EDCdetermine" value="LMP confirmed by 1st tri U/S|1st tri U/S"][/conditional][conditional field="EDCdetermine" condition="(EDCdetermine).is('1st tri U/S')"] [select name="disconcordantdates" value="(disconcordant with EDC by LMP)|"][/conditional][conditional field="disconcordantdates" condition="(disconcordantdates).is('')"][text size="60"][/conditional][conditional field="Interpretation" condition="(Interpretation).isNot('Intrauterine Pregnancy')"].
[textarea rows="3"][/conditional][conditional field="Interpretation" condition="(Interpretation).is('Intrauterine Pregnancy')"][/conditional][conditional field="firsttrius" condition="(firsttrius).is('First Trimester Ultrasound Report')"]
DISCLAIMER: Discussed with patient the limitations of this ultrasound, inability to completely rule out ectopic/heterotopic pregnancies, inability to rule out pelvic gynecologic pathologies, inability to rule out genetic abnormalities, and inability to rule out congenital malformations/deformities.[/conditional][conditional field="firsttrius" condition="(firsttrius).is('First Trimester Ultrasound Report')"]
Plan:[checkbox value="no significant concerns|followup with assigned OB provider for routine prenatal care|immediate referral to OB/Gyn for further evaluation|obtain/order serial quantitative serum HCG levels with appropriate f/u"][comment memo="freetext" memo_size="small" memo_color="blue"][textarea rows="3"][/conditional]
[checkbox memo="*" memo_size="small" memo_color="blue" name="endfreetext" value="Additional comments:"][conditional field="endfreetext" condition="(endfreetext).is('Additional comments:')"] [textarea default="none"][/conditional]