3 Tips to avoid panic setting in when the organ you're looking for isn't where you expect it to be?

Introduction: The Unsettling Moment

We've all been there. That feeling of uneasiness or nervousness. Your heart beating a little faster. All because the organ you're looking for isn't where you expected it to be!

In my experience, it’s definitely something I hear about a lot when people are starting to learn to ultrasound. Time seems to drag on forever when you can't locate the organ you need. I can relate to the mounting sense of panic that comes with this situation.

Personal Experiences: Teaching and Scanning Challenges

I remember a time when I was just starting out teaching ultrasonography, and I had 12 students around me, and the right kidney wasn't popping into view where I'd expected it. Panic started to fill my body, along with an uncomfortable feeling of being judged by those around me.

I've also had that feeling with the person restraining the patient, paranoid that they know I'm struggling to find something. Another time when I was scanning a patient, I scanned the liver as normal, then I scanned the stomach, and then I went to scan the spleen, but the next organ that showed up was the left kidney. Hang on a moment! I needed to check the spleen, but it wasn't there. I was fanning and looking for the spleen and just couldn't find it.

So what can you do in these situations?

What did I do?

Dealing with Panic: Strategies in the Heat of the Moment

Well, in the first situation where I was struggling to find the right kidney, I stopped, took a breath, and thought about the likelihood of the right kidney being missing. It was extremely unlikely. This was a healthy patient. It was a teaching patient, so we were expecting there to be a right kidney. I decided to imagine a wedge, a three-dimensional wedge over the area where I expected to see the right kidney, and I scanned that entire area. With this systematic approach within that area, the right kidney eventually popped into view, and the panic was over.

Case Study: When History Holds the Key

In the second situation with the spleen missing, I spent quite a long time looking for it before it dawned on me that this was a patient where the spleen may have been removed. We checked the history, and indeed the dog had previously had a splenectomy.

So, with my own experiences, what are my takeaway tips for you when the organ you're looking for isn't where you expect it to be?

Takeaway Tips for Handling Unexpected Scenarios

Tip no. 1 - Check that the organ you are trying to find hasn’t already been removed by previous surgery, or it doesn’t have a congenital defect, which means that an organ, such as a kidney, may not be present.

Tip no. 2 - Increase your depth on the ultrasound machine. You want to be looking way deeper than you expect to find the organ or structure because otherwise the organ or structure might be just outside your image.

Tip no. 3 - Search the area in a systematic way. Imagine a three-dimensional wedge around the object where you'd expect the old organ to be. Then systematically fan through that area, going further than you'd expect in every direction.

I hope these tips help you next time panic starts to set in. And remember, we’ve all been there!

Good luck.

Camilla