Page 143 - JSOM Summer 2018

An Ongoing Series

Intelligent Exam for Crucial Intelligence . . .

Christopher Dare, SOIDC ; Katarzyna (Kasia) Hampton, MD *
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n an attempt to gather crucial intelligence, your team is at- treatment for the sheik’s daughter. He returns the favor by of-
Itending a Key Leaders Engagement with the village elders in fering crucial intelligence to your team.
a remote Middle Eastern location. As the meal is being served,
you note that one of the women appears to be “doubled-over” 1. What is the most likely diagnosis, and what suggestive find-
in pain. You ask your translator to pass that observation to ings are present in Figure 1?
the village sheik and request his permission to evaluate her. It 2. Is the heart rate of 50 beats/min reassuring or more worri-
turns out she is the sheik’s daughter, who was recently married. some in this scenario, and why?

Chaperoned by a group of other women, you start your assess- Join us at SOFsono.org for further case discussion.
ment. The translator lets you know she has severe abdominal
pain that started suddenly a few hours ago. Last mentrual pe- FIGURE 1 Female pelvis, sagittal view.
riod was 8 weeks ago. The initial vital signs are heart rate of
50 beats/min, blood pressure of 90/65mmHg, respirations of
26/min, Spo of 99% on room air, and temperature of 36.6ºC
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(98ºF).
On physical examination, you observe a very uncomfort-
able-appearing thin young woman. Even though you need to
complete your exam using the untrained hands of her female
companion, you are able to determine that she has severe ab-
dominal tenderness, primarily in both of the lower quadrants.
The reminder of her exam is unremarkable.
Given your differential includes a potentially life-threatening
condition, you pull out your pocket-sized ultrasound device
and hook up the probe to your smartphone. Again, the trans-
lator helps you guide the patient’s female companion in probe
placement on the abdominal wall. Within seconds, your worst
suspicion becomes obvious. You manage to arrange life-saving

*Correspondence to sofsono.org@gmail.com
1 CPO Dare is a Special Operations Independent Duty Corpsman (SOIDC) and is currently the Navy Senior Enlisted Leader at 1st Reconnais-
sance Battalion. Dr Hampton is an emergency physician and a volunteer SME ultrasound instructor for the military medical community. She is
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currently practicing at the Landstuhl Regional Medical Center, Germany (US Army Medical Department).
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