Post on 04-Jan-2016
description
Emergency Emergency Ultrasound in TraumaUltrasound in Trauma
Fahad Khan, MDFahad Khan, MDSt. Luke’s/Roosevelt Hospital CenterSt. Luke’s/Roosevelt Hospital CenterColumbia University, New York CityColumbia University, New York City
April 24, 2009April 24, 2009
EE-FAST-FAST Focused Assessment with Focused Assessment with
Sonograghy for TraumaSonograghy for Trauma CardiacCardiac RUQRUQ LUQLUQ PelvisPelvis
ExtendedExtended Lung bases for pleural fluidLung bases for pleural fluid Anterior lung apices for pneumothoraxAnterior lung apices for pneumothorax
IndicationsIndications
Blunt thoraco-abdominal trauma Blunt thoraco-abdominal trauma Unexplained hypotensionUnexplained hypotension Trauma in pregnancyTrauma in pregnancy
Key QuestionsKey Questions
Is there FREE FLUID present?Is there FREE FLUID present? In the pericardial spaceIn the pericardial space In the peritoneal cavityIn the peritoneal cavity In the pleural spaceIn the pleural space
Is there a PNEUMOTHORAX?Is there a PNEUMOTHORAX?
AdvantagesAdvantages
RapidRapid ReproducibleReproducible Non-invasiveNon-invasive PortablePortable No radiation or contrastNo radiation or contrast
DisadvantagesDisadvantages
Difficult to distinguishDifficult to distinguish Type of fluidType of fluid Solid organ injurySolid organ injury
Cannot evaluate retroperitoneumCannot evaluate retroperitoneum Difficult in the obese patientDifficult in the obese patient
AlgorithmAlgorithm
Blunt Thoraco-abdominal Trauma
Hemodynamically Stable Hemodynamically Unstable
Peritoneal Signs
LaparotomyUltrasound
Free Fluid/Organ Injury
Laparotomy CT Scan
UltrasoundFree Fluid/Organ Injury
LaparotomyRepeat U/S
CT Scan
TechniqueTechnique
Low frequency Low frequency probeprobe
2.5 – 5.0 MHz2.5 – 5.0 MHz Tissue penetrationTissue penetration
Hepato-renal RecessHepato-renal Recess
Trendelenburg positionTrendelenburg position Anterior axillary lineAnterior axillary line
Lung Scanning for Lung Scanning for PneumothoraxPneumothorax
““Bat” SignBat” Sign Comet tailsComet tails
PitfallsPitfalls
Scan all quadrantsScan all quadrants Repeating scansRepeating scans Inferior polesInferior poles Solid organ injuriesSolid organ injuries FatFat RetroperitoneumRetroperitoneum
After a short training program, physicians After a short training program, physicians can use FAST in early assessment of trauma can use FAST in early assessment of trauma patients with sufficient specificity to patients with sufficient specificity to expedite decision making. expedite decision making.
Increased physician ultrasound experience is Increased physician ultrasound experience is associated with increased physician accuracy associated with increased physician accuracy in FAST examinations.in FAST examinations.
This can directly lead to a reduction in the use This can directly lead to a reduction in the use of CT scans, and ultimately, medical costs.of CT scans, and ultimately, medical costs.