Brought to you by. Frequency of positive patients to eco-fast and later CT in major abdominal trauma: our experience. Purpose To evaluate the frequency of patients which are positive for eco-fast and following multislice CT in case of significant non-penetrating abdominal traumas received into Emergency department Caserta's A. Focused Assessment with Sonography for Trauma commonly abbreviated as FAST is a rapid bedside ultrasound examination performed by surgeons and emergency physicians as a screening test for blood around the heart pericardial tamponade or abdominal organs hemoperitoneum after trauma.
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NCBI Bookshelf. Benjamin A. Bloom ; Ryan C. Authors Benjamin A. Bloom 1 ; Ryan C. Gibbons 2. Eighty percent of traumatic injury is blunt with the majority of deaths secondary to hypovolemic shock . The optimal test should be rapid, accurate, and non-invasive. Historically, providers performed diagnostic peritoneal lavage DPL to detect hemoperitoneum.
CT remains the gold standard for diagnosing intra-abdominal injuries detecting as little as cc of intraperitoneal fluid. However, time delays and transportation out of the emergency department confound the evaluation of hemodynamically unstable patients. Ultrasound has considerable advantages, including its bedside availability, ease of use, and reproducibility. Furthermore, it is non-invasive, employs no radiation or contrast agents, and is inexpensive. However, widespread adoption in the United States did not occur until the s.
The eFAST examines each hemithorax for the presence of hemothoraces and pneumothoraces. The FAST exam evaluates the pericardium and three potential spaces within the peritoneal cavity for pathologic fluid. Start with your hand against the bed to ensure visualization of the retroperitoneal kidney. Most importantly, remember to assess each of these areas while scanning the RUQ. Next, obtain subxiphoid or subcostal views to evaluate the pericardial space.
Traumatic pericardial tamponade happens rapidly with as little as 50cc to cc preventing the pericardial compliance from accommodating as it does with gradually accumulating effusions common in numerous chronic medical conditions. There are several sonographic findings of cardiac tamponade. Most are beyond the scope of this review. Right ventricular collapse during ventricular diastole and inferior vena cava IVC plethora are the easiest and most frequently observed.
The subcostal view helps differentiate between pleural and pericardial effusions as well since there is no pleural reflection present. Following the subxiphoid view, image the left upper quadrant LUQ to inspect the splenorenal recess, the subphrenic space, and the left paracolic gutter, as well as the left lower hemithorax when performing an Extended FAST exam eFAST. Obtain similar views of the right hemithorax when scanning the RUQ.
For each hemithorax view, simply slide the probe cranially above the diaphragm. Finally, suprapubic images evaluate for free fluid in the rectovesical pouch in males and the rectouterine Pouch of Douglas and vesicouterine pouches in females. In addition to the anatomy described above, the eFAST incorporates views of the right and left anterior hemithoraces to detect the presence of a pneumothorax.
Typically, a small amount of pleural fluid lines the interface between the parietal and visceral pleurae, allowing for synchronized lung and chest wall expansion and contraction during inhalation and exhalation, respectively.
There are no absolute contraindications to the eFAST. However, eFAST should not delay resuscitative efforts for patients in extremis. However, the phased array or cardiac probe is effective as well, particularly with parasternal windows.
Sweep anteriorly and posteriorly to evaluate the entirety of this space. Slide the probe caudally to evaluate the liver tip and the right paracolic gutter. Move the probe cephalad to visualize the diaphragm and inferior hemithorax, utilizing the liver as an acoustic window.
Rib shadowing may obscure imaging. Mitigate this complication by rotating the probe to an oblique position. Additionally, if the patient is alert and cooperative, have the patient inhale deeply and hold. This will displace intraabdominal contents inferiorly below the ribs, allowing for a more complete visualization of the dependent recesses. Increase the depth in order to view the entire pericardium.
Use the liver as an acoustic window to enhance your image. Typically, a shallow probe angle of less than 15 degrees is necessary to see the entire cardiac silhouette.
An overhand grip is ideal to achieve this angle of approach. Patient body habitus can limit the subxiphoid window. Have the patient inhale deeply or try parasternal windows to assess for pathologic pericardial fluid.
LUQ: Typically, the left upper quadrant dependent recesses are more posterior and cephalad since the spleen is generally smaller than the liver. Begin with the transducer along posterior axillary line between the 6 and 9 rib spaces in the sagittal orientation.
Fan anteriorly and posteriorly to survey the splenorenal and perisplenic spaces. Move cephalad to view the subphrenic space and the left inferior hemithorax. Slide caudally to image the left paracolic gutter. Suprapubic: Locate the pubic symphysis and place the transversely oriented probe immediately cephalad to it. A full bladder is preferable, however if the bladder is decompressed aim the probe caudally.
Increase the depth to visualize posterior to the bladder where free fluid collects. Sweep caudally and cephalad to obtain complete views of the rectovesical space in men and the rectouterine and vesico-uterine pouches in women.
These pouches are the most dependent recesses of the intraperitoneal cavity. In order to achieve greater sensitivity, rotate the probe 90 degrees clockwise into the sagittal orientation to best assess the pouch of Douglas and vesico-uterine pouch in women.
This is the most anterior portion of the thoracic cavity where free air accumulates as a pneumothorax. Absence of this movement is indicative of disruption between the serosal membranes by the presence of air. The presence of comet tail artifacts and B-lines indicate the absence of a pneumothorax, though. If B-mode imaging is equivocal for lung sliding, change to M-mode. The resulting grayscale heterogenous image will have a distinct interface at the level of the pleurae.
Likewise, the presence of a lung-point sign is virtually pathognomonic of a pneumothorax. There are no known complications from the eFAST exam. However, ultrasound has several limitations. Other false negatives include patients with delayed presentations whose hemorrhage has clotted causing a mixed echogenicity rather than the anechoic or black appearance of fresh blood or fluid.
False positives include ascites, peritoneal dialysate, ruptured ovarian cysts, and ruptured ectopic pregnancies. Additionally, ultrasound cannot distinguish between blood and urine in severe pelvic trauma and cannot evaluate retroperitoneal hemorrhages. Ultrasound has revolutionized the care of traumatic injuries. Numerous studies, albeit mostly observational, have demonstrated that the eFAST protocol is a clinically significant adjunct in the evaluation and treatment of trauma patients.
As with any imaging modality though, recognize and understand its limitations. The management of trauma patients is usually with an interprofessional team including trauma nurses. While FAST is useful in trauma patients, it has limitations.
A radiologist should be consulted if one is not able to interpret the images; unfortunately this may not always be possible in the middle of the night. To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Author Information Authors Benjamin A.
Affiliations 1 Temple University Hospital. Anatomy and Physiology The FAST exam evaluates the pericardium and three potential spaces within the peritoneal cavity for pathologic fluid. Clinical Significance Ultrasound has revolutionized the care of traumatic injuries.
Enhancing Healthcare Team Outcomes The management of trauma patients is usually with an interprofessional team including trauma nurses. Questions To access free multiple choice questions on this topic, click here. References 1. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med.
Preventable or potentially preventable mortality at a mature trauma center. J Trauma. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography?
Griffin XL, Pullinger R. Are diagnostic peritoneal lavage or focused abdominal sonography for trauma safe screening investigations for hemodynamically stable patients after blunt abdominal trauma? A review of the literature. Is closed diagnostic peritoneal lavage contraindicated in patients with previous abdominal surgery? Acad Emerg Med.
Sonography versus peritoneal lavage in blunt abdominal trauma. Prospective study to evaluate the influence of FAST on trauma patient management.
Frequency of positive patients to eco-fast and later CT in major abdominal trauma: our experience
NCBI Bookshelf. Benjamin A. Bloom ; Ryan C. Authors Benjamin A.
Focused assessment with sonography for trauma
Rev Colomb Anestesiol. E-mail address: jagiraldor hptu. A systematic search was conducted in the following databases: Pubmed, Medline, SciELO, and Lilacs using the keywords ultrasonography, trauma, hemoperitoneum, and abdominal injury. The main purpose of this review was to provide clear objectives and concepts on how to perform the FAST and FAST extended examinations properly, emphasizing the techniques that should be used and the appropriate ultrasonography windows. Photographs taken by the authors are included. Utilizando como palabras clave: Ultrasonography, Trauma, hemoperitoneum, abdominal injury.
Focused assessment with sonography in trauma commonly abbreviated as FAST is a rapid bedside ultrasound examination performed by surgeons, emergency physicians, and certain paramedics as a screening test for blood around the heart pericardial effusion or abdominal organs hemoperitoneum after trauma. The four classic areas that are examined for free fluid are the perihepatic space including Morison's pouch or the hepatorenal recess , peri splenic space, pericardium , and the pelvis. With this technique it is possible to identify the presence of intraperitoneal or pericardial free fluid. In the context of traumatic injury, this fluid will usually be due to bleeding.