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  • USQAform

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    pegehring
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    This ultrasound report form contains sections to document the findings of various ultrasound examinations including FAST, AAA, renal, biliary, pregnancy, cardiac, and procedural ultrasounds. It includes fields to note the indication for the exam, the radiologist's impression, measurements, presence of fluid or stones, and whether images submitted are adequate.

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    QA form for UF-Jax EM Ultrasound

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    This ultrasound report form contains sections to document the findings of various ultrasound examinations including FAST, AAA, renal, biliary, pregnancy, cardiac, and procedural ultrasounds. It includes fields to note the indication for the exam, the radiologist's impression, measurements, presence of fluid or stones, and whether images submitted are adequate.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Scarica in formato PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    35 visualizzazioni2 pagine

    USQAform

    Caricato da

    pegehring
    This ultrasound report form contains sections to document the findings of various ultrasound examinations including FAST, AAA, renal, biliary, pregnancy, cardiac, and procedural ultrasounds. It includes fields to note the indication for the exam, the radiologist's impression, measurements, presence of fluid or stones, and whether images submitted are adequate.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Scarica in formato PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    di 2

    Your

    Name_______________
    Patient
    Date__________________
    Emergency Sticker
    here
    Attending______________ Ultrasound
    Indication:____________________________________________

    Your Impression:_______________________________________

    F.A.S.T. (4) AAA (4)

    SUBX
    Liver-cardiac interface
    heart LUQ
    Spleen
    Kidney
    RUQ Diaphragm
    Liver Splenorenal
    Kidney recess
    Diaphragm LONG XVERSE
    Morrison’s pouch Superior
    Middle
    SUP Bifurcation
    Bladder
    Retroves.
    space
    +-/- Uterus

    Effusion? Y N Free Fluid? Y N Measurement:________cm

    BILIARY (2) RENAL (3)

    XVERSE
    Poles
    Mid
    LONG
    SUP
    Bladder
    Retrovesicular LONG
    XVERSE space
    Neck +-/- Uterus
    Body
    Fundus

    Free Fluid? Y N
    Stones? Y N CBD : _______mm Stones? Y N Hydro? Y N

    Please circle all views submitted. Minimum number of views to submit in parentheses!
    Please circle all views submitted. Minimum number of views to submit in parenthe-

    PREGNANCY (2) CARDIAC (2)


    TRANSABD TRANSVAG PARAST
    PARAST LONG
    SHORT RV
    RV LA & LV
    LV

    XVERSE LONG
    Uterus Uterus APICAL
    Endomet. stripe Endomet. stripe SUBX LA & LV
    Vesicouterine Bladder Liver RA & RV
    space Vaginal Stripe Heart Ventric. Septum
    Rectouterine space pericardium
    Fetus/ yolk sack

    Adenexa seen? Y N IUP? Y N Cardiac Activity? Pericardial Effusion?


    Free Fluid? Y N FHT? Y N Y N Y N

    PROCEDURES OTHER
    Central Line: Ocular
    Fem IJ SubClav Extremity for DVT
    Paracentesis Soft Tissue
    Thoracentesis Foreign Body
    Peripheral Venous Access Pneumothorax
    Arthrocentesis Other:______________________
    Pericardiocentesis
    Lumbar Puncture
    Suprapubic Catheter
    Procedure Successful? Y N

    FOR QA USE ONLY!!!!!


    Images Adequate: Y N
    Attending at Bedside: ______________________________
    Confirmation Study: CT US OR
    Procedural Success: Y N
    Diagnosis Correct: Y N

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