The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to...
Transcript of The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to...
![Page 1: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/1.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
WINFOCUS’ BASIC ECHO (WBE)!
Thomas White, MD, FACS
Trauma Surgery and Critical Care
Intermountain Medical Center
Salt Lake City, Utah
The FAST Exam
![Page 2: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/2.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Focused
Assessment
with Sonography
in Trauma
!
!
Text
FAST
ocused ssessment with onography in rauma
FAST
Not just for trauma…….
Finding/confirming ascites!Splenic artery or aortic aneurysm rupture, hollow viscus perforation, ectopic pregnancy, postop bleeding
![Page 3: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/3.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
• A limited ultrasound examination for the detection of free fluid in the chest, abdomen or mediastinum
• Advanced/expanded
• Rapid detection of pneumothorax
• Not included
• identification of solid organ injury
Goals of FAST
![Page 4: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/4.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Indications for FAST
• Blunt and penetrating thoracoabdominal trauma
• Trauma or abdominal pain and pregnancy
• Unexplained hypotension in any patient
• CONTRAINDICATION - other indication for the OR
!
!
!
![Page 5: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/5.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
How to - Quick review
• Probe marker always to patient’s head or to patient’s right
• Gentle compression – Eliminate bowel gas, improve skin-transducer
interface
• Low-frequency probe – Larger, deeper structures
![Page 6: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/6.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
FAST – FOUR VIEWS
• sub-xiphoid !
• RUQ !
• LUQ !
• Pelvic !
based on 3 most dependent areas of peritoneum as well as view of the heart
![Page 7: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/7.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
WINFOCUS’ BASIC ECHO (WBE)!
Subxiphoid
![Page 8: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/8.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
RARV
LA LV
Subxiphoid
![Page 9: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/9.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
RARV
LA LV
Subxiphoid
![Page 10: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/10.jpg)
![Page 11: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/11.jpg)
![Page 12: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/12.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Things to be concerned about….
Scalloping of Right
Ventricle
![Page 13: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/13.jpg)
Things to be concerned about….
![Page 14: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/14.jpg)
Things to be concerned about….
![Page 15: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/15.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!Parasternal Long View
• Probe is on left side of sternum
!• Used to visualize aortic
outflow tract
Nice alternative view for subxiphoid (obese, abdominal pain, postop).!!wrong probe, terrible technique
![Page 16: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/16.jpg)
![Page 17: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/17.jpg)
![Page 18: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/18.jpg)
![Page 19: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/19.jpg)
![Page 20: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/20.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Upper quadrant landmarks
RUQ LUQ
![Page 21: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/21.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
• Potential space between Gerota’s fascia of the right kidney and Glisson’s capsule of the liver
• Dependent region of right upper abdomen in the supine patient
Morrison’s Pouch
![Page 22: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/22.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!Morrison’s Pouch - Anatomy
Spleen
R Kidney
Liver
L Kidney
![Page 23: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/23.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!Morrison’s Pouch - Anatomy
Spleen
R Kidney
Liver
L Kidney
(Morrison’s Pouch
![Page 24: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/24.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
![Page 25: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/25.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
• Technique:
– Midaxillary line – Horizontal subxiphoid
line – Fan posteriorly
Morrison’s Pouch
![Page 26: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/26.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Morrison’s Pouch
• Examine for:
–Fluid in Morrison’s pouch
–Fluid in right paracolic gutter
–Fluid in subdiaphragmatic space
–Fluid in right pleural space (cephalad to diaphragm)
![Page 27: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/27.jpg)
!
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
![Page 28: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/28.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
![Page 29: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/29.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Morrison’s Pouch
• REMEMBER the INFERIOR POLE of the kidney!
![Page 30: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/30.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
![Page 31: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/31.jpg)
Morrison’s Pouch
![Page 32: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/32.jpg)
Morrison’s Pouch
![Page 33: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/33.jpg)
Morrison’s Pouch
![Page 34: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/34.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Hemothorax
• Loss of mirror image artifact
• Anechoic wedge superior to the liver and spleen
• Extension of the Thoracic Line
![Page 35: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/35.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Mirror Image
![Page 36: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/36.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Mirror Image
![Page 37: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/37.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
“spine sign”
![Page 38: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/38.jpg)
![Page 39: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/39.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Splenorenal Recess
– Potential space between spleen and left kidney
– Dependent region of left upper abdomen
![Page 40: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/40.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Splenorenal Recess - Anatomy
Spleen
R Kidney
Liver
L Kidney
![Page 41: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/41.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Splenorenal Recess - Anatomy
Spleen
R Kidney
Liver
L Kidney
)
Splenorenal Recess
![Page 42: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/42.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
•Technique:
• Posterior axillary line
• Horizontal subxiphoid line
• Fan posteriorly
Splenorenal Recess
![Page 43: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/43.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
• Examine for:
– Fluid in splenorenal recess
– Fluid in left paracolic gutter
–Fluid in subdiaphragmatic space
– Fluid in left pleural space (cephalad to diaphragm)
Splenorenal Recess
![Page 44: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/44.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
KIDNEY
DIAPHRAGM
SPLEEN FLUID
![Page 45: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/45.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
FLUID ABOVE SPLEEN
LEFT LUNG
SPLEEN
DIAPHRAGM
![Page 46: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/46.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Splenorenal Recess
![Page 47: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/47.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Splenorenal Recess
![Page 48: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/48.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Splenorenal Recess
![Page 49: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/49.jpg)
![Page 50: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/50.jpg)
![Page 51: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/51.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Pelvis
• Pouch of Douglas/Rectovesicular space
• Dependent region of lower abdomen
![Page 52: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/52.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Pelvis – Female Anatomy
Rectouterine Pouch
(of Douglas)
Vesicouterine Pouch
![Page 53: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/53.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Pelvis – Male Anatomy
Rectovesical Recess
![Page 54: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/54.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Pelvis
•Technique:
• Suprapubic (2 cm above symphysis pubis)
• Start midline
• Longitudinal and transverse planes
• Ideally prior to emptying of bladder via Foley (clamp)
• FANNING!!
clamp or lift bag to fill bladder (hey, its their urine after all...)
![Page 55: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/55.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
• Examine for: –Fluid posterior to bladder
–Fluid posterior to uterus
–Fluid between bowel loops
Pelvis
![Page 56: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/56.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
WINFOCUS’ BASIC ECHO (WBE)!
![Page 57: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/57.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Blunt Abdominal Trauma (BAT)
• Diagnostic Options:
![Page 58: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/58.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Blunt Abdominal Trauma (BAT)
• Diagnostic Options:
DPL
![Page 59: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/59.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Blunt Abdominal Trauma (BAT)
• Diagnostic Options:
CT
DPL
![Page 60: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/60.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Blunt Abdominal Trauma (BAT)
• Diagnostic Options:
CT
DPL
FAST
![Page 61: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/61.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
FAST and Hemoperitoneum
• Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90%
• Specificities 95-100% in multiple studies
• Time < 4 minutes in most studies
• Reliably detects 200-650 cc of intraperitoneal blood
• 650 cc based on Branney study, single view
• CT 100-250 cc
• DPL - 100,000 RBC/mm3 = 20 cc in 1 L IVF
![Page 62: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/62.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Advantages to FAST• Compared to DPL:
– Noninvasive
– Repeatable
– Complication-free
– Not contraindicated by previous surgeries
– Capable of identifying pericardial and pleural fluid
– Cost-effective
– Higher specificity for therapeutic laparotomy
![Page 63: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/63.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Advantages to FAST
• Compared to CT: – Available for hemodynamically-
unstable patients – Portable – Rapid – Repeatable – Does not require contrast or
radiation – Cost-effective
![Page 64: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/64.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Disadvantages to FAST
• Operator-dependent
• Difficult in obese patients or those with subcutaneous air or excessive bowel gas
• Less accurate in diagnosing specific organ lesion
• Less accurate in diagnosing retroperitoneal injury
![Page 65: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/65.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Disadvantages to FAST
• infers rather than proves injury
• may miss retroperitoneal, or diaphragmatic injuries
![Page 66: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/66.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Outcome trials• Outcome Assessment:
– 135 PLUS, 127 controls – Time to operative care 64% less for PLUS
patients – PLUS patients spent 27% fewer days in hospital – PLUS patients underwent fewer CTs – PLUS patients had fewer complications – PLUS patient charges were 35% less
Melniker LA , Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited sonography for trauma in the emergency department: the
first sonography outcomes assessment program trial. Ann Emerg Med 2006;48(3):227-35.
![Page 67: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/67.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Literature to know
• Echo decreases time to OR and mortality
Plummer, D, Brunnette D, Asinger R, Ruiz E. Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann Emerg Med 1992; 21:709-712.
!Rozycki, GS, Feliciano DV, Ochsner MG, et al. The role of ultrasound in patients with
possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 1999; 46:543-51.
US group 100% survival; time to OR 15 min
Controls 57% survival; time to OR 42 min
![Page 68: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/68.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
FAST Algorithms
![Page 69: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/69.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
Pitfalls in FAST
• Failure to scan all four views
• Failure to note echogenic clotted blood
• Failure to perform serial exams
• Failure to scan the inferior renal poles, subdiaphragmatic region on left and sagittal bladder view
• Humility with any new skill…
![Page 70: The FAST Exam - IntermountainPhysician...FAST and Hemoperitoneum • Sensitivities range from 69% to high 90’s • McGahan J US Med 1997 500 pts - sensitivity 63% >90% • Specificities](https://reader033.fdocuments.in/reader033/viewer/2022042200/5ea03886315a1d207360c0d4/html5/thumbnails/70.jpg)
© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY
!
END