Extended FAST Exam. Goal of Trauma Care. Golden Hour of Trauma
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1 Extended FAST Exam Goal of Trauma Care Golden Hour of Trauma
2 Best INITIAL screening modality in trauma efast
3 2014 LLSA Article (ACEP Policy Statement) Level B Recommendation: In hemodynamically unstable patients (SBP 90 mmhg) with blunt abdominal trauma, bedside ultrasound, when available, should be the initial diagnostic modality performed to identify the need for emergent laparotomy efast Indications Bedside Non-invasive Repeatable Rapid No Contraindications Blunt or penetrating trauma to the abdomen or chest Trauma in pregnancy Unexplained hypotension Thoraco-Abdominal Anatomy - between the ribs
4 Need to move probe from diaphragm to lower pole of kidney Liver Kidney superior pole Diaphragm Morison's pouch Diaphragm Kidney (inferior pole) Right Upper Quadrant If Eyes are the Window to the Soul, then Liver is the Window to the Heart Start at liver edge and follow the subcostal margin until heart is seen Aim beam at chin Never cross midline Sub-Xiphoid Window
5 SubXiphoid View Liver ParaSternal Long 15% of the time unable to obtain sub-xiphoid Place the sound along the long axis of the heart ParaSternal Long Point indicator towards the patient s left elbow
6 ParaSternal Long RV LV LA Left Upper Quadrant Left Upper Quadrant
7 Suprapubic View - Sagittal Transducer just superior to the pubic symphysis Fan side to side looking for anechoic wedges Suprapubic view - Sagittal Bladder Vesico-uterine space Recto-uterine space Uterus Suprapubic Window
8 Suprapubic view - Transverse Transducer just superior to pubic symphysis Mirror Image Artifact Sound glances off diaphragm, returning to probe with a longer time of flight Machine misinterprets this as more liver tissue further afield Mirror Image Artifact
9 Hemothorax Normal Pitfalls: Epicardial Fat Gastric Fluid Stomach Spleen
10 Hemoperitoneum Fluid in Stomach Blunt Trauma Algorithm Positive FAST Negative FAST Stable Unstable Stable Unstable CT OR CT??
11 Case 1: Blunt Traumatic Full Arrest Case 2: Auto vs Peds Case 3: Stab Wound to Left Upper Quadrant
12 Case 4: Fall from Ladder, on Coumadin Case 5: Stab Wound to Right Upper Quadrant Case 6: Fell off Motorcycle
13 Case 7: Auto vs Peds Pneumothorax? Pneumothorax? Sensitivity of supine AP CXR is 47-75%
14 Compare AP chest x-ray with ultrasound for the diagnosis of pneumothorax Pneumothorax - Methods English-language articles on the performance of chest x-ray and ultrasonography in the diagnosis of a pneumothorax were selected In eligible studies, data were recalculated, and the forest plots were analyzed Chest Oct;140(4): Ultrasound 88% Sensitive Sensitivity Chest Xray 52% sensitive Chest Oct;140(4):859-66
15 Ultrasound 99% Specific Specificity Chest Xray 100% Specific Chest Oct;140(4): Sonographic Technique High frequency linear probe 2nd intercostal space Mid-clavicular line 4-5 respiratory cycles B-Mode and M-mode Pneumothorax Technique Pleural interface Air in lung impairs transmission of sound Pleural interface is visible Visualize visceral & parietal pleura sliding on each other
16 Pneumothorax Technique With pneumothorax, lung falls away from chest wall Air separates the pleura Pleural interface is no longer seen by the probe Pneumothorax? Pneumothorax?
17 Pneumothorax? Pneumothorax? Pneumothorax?
18 Pneumothorax? Sky-Ocean-Beach Depress M-mode key Place cursor line across pleural line Depress M-mode key again to generate an M-mode tracing Sky-Ocean-Beach B-Mode M-Mode Sky Ocean Beach
19 Sky-Ocean-Beach B-Mode M-Mode Sky Ocean No Beach Sky-Ocean-Beach efast Summary Hepato-Renal Cardiac Spleno-Renal Suprapubic 1. Pleural Line 2. Lung Sliding 3. M-mode (S-O-B)
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