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

Intraperitoneal Fluid Intraperitoneal Fluid FlowFlow

TechniqueTechnique

Low frequency Low frequency probeprobe

2.5 – 5.0 MHz2.5 – 5.0 MHz Tissue penetrationTissue penetration

Sub-xiphoidSub-xiphoid

Pericardial FluidPericardial Fluid

Pericardial EffusionPericardial Effusion

Hepato-renal RecessHepato-renal Recess

Trendelenburg positionTrendelenburg position Anterior axillary lineAnterior axillary line

Hepato-renal FluidHepato-renal Fluid

Right Lung BaseRight Lung Base

Move probe cephaladMove probe cephalad

Spleno-renal RecessSpleno-renal Recess

Spleno-renal FluidSpleno-renal Fluid

Left Lung BaseLeft Lung Base

Move probe cephaladMove probe cephalad

PelvisPelvis

Pelvic Free FluidPelvic Free Fluid

TechniqueTechnique

Lung Scanning for Lung Scanning for PneumothoraxPneumothorax

““Bat” SignBat” Sign Comet tailsComet tails

Normal LungNormal Lung

PneumothoraxPneumothorax

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.

Questions?Questions?