Ultrasound in Trauma: Past, Present and · PDF file9/22/2014 1 Ultrasound in Trauma: Past,...
Transcript of Ultrasound in Trauma: Past, Present and · PDF file9/22/2014 1 Ultrasound in Trauma: Past,...
9/22/2014
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Ultrasound in Trauma:Past, Present and
FutureAdeyinka A. Adedipe MD
Division of Emergency MedicineUniversity of Washington
Objectives
How is bedside US is used to evaluate trauma patients?
What are the advantages and limitations of bedside US in trauma care?
What is new in US for trauma care?
The Past . . .
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Case 1: Big City, USA
26 year old male Restrained driver HRMVA
Obtunded at scene w/prolonged extrication
HR: 118 BP:88/67 RR:6
EMS: 2 large IVs and intubation
Case 1: Big City, USA
Primary Survey
HR: 121 BP:85/53 RR:12 (bagged) 8.0 ETT Bilateral BS Weak femoral pulses/stable pelvis Pupils 32 bilaterally, MAE
Case 1: Big City, USA
Secondary Survey
Abdominal tenderness diffusely
Ecchymosis on the chest, abdomen and pelvis
Gross deformity of left leg
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. . . the FAST
Primary Indications
Identify intraperitoneal hemorrhage
Identify pericardial effusion
Identify hemothroax
Main Views
Hepatorenal
Splenorenal
Suprapubic
Subxiphoid
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Hepatorenal Space
Hepatorenal
Identify: Diaphragm Liver Kidney
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Splenorenal Space
Splenorenal
Identify: Diaphragm Spleen Kidney
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Suprapubic
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Suprapubic
Identify: Bladder Uterus (+/-)
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Advantages
Sensitive Rapid Bedside Test Noninvasive Non-ionizing Repeatable
Limitations
Retroperitoneum Solid Organs Hollow viscous
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The Present . . .
Case 2: Small Town, USA
26 year old male Stab wound to the anterior chest
Awake and alert at scene HR: 118 BP:88/67 RR: 20
EMS: 2 large bore IVs
Case 2: Small Town, USA
Primary Survey: HR: 118 BP:88/67 RR: 20 Patent airway Bilateral BS Weak radial pulse MAE to command
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Case 2: Small Town, USA 2cm laceration to chest
Faint heart sounds
Radial pulse diminishes with inspiration
Prominent neck veins and upper torso plethora
. . . the E-FAST
The Extended FAST
Emphasis on identifying pericardial hemorrhage
Identify pneumothroax
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Subxiphoid
Subxiphoid
Below costal margin
Scan through the liver
Subxiphoid
Identify: Pericardium Right ventricle Left ventricle
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Thoracic Views
Hemothorax
Begin at mid-axillary line, below rib margin
Slide superiorly above level of
diaphragm
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Pneumothorax
Midclavicular line, 2nd or 3rd intercostal space
FIN
Normal Lung: pleural slide and comet tail artifacts
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Pneumothorax: loss of pleural slide
The Future . . .
Case 3: Remote Village, Far Away Nation
26 year old male Kicked in the abdomen by a horse
Family arranged for a cart to transport the patient
Its taken them 5 days to get over the mountain range
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Case 3: Remote Village
Primary Survey
HR: 118 BP: 88/67 RR: 24 Patent airway Bilateral BS Weak radial pulse/stable pelvis Lethargic, but neuro intact
Case 3: Remote Village
Secondary Survey
Abdominal tenderness diffusely
Rebound and guarding
Ecchymosis around the umbilicus
. . . the iFAST?
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TeleSonography
J Trauma, 2010
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Resuscitative US
J Trauma, 2009
J Trauma Acute Care Surg, 2014
Summary
FAST
E-FAST
i-FAST
ReferencesWilliams SR, et al The FAST and E-FAST in 2013: trauma ultrasonography:
overview, practical techniques, controversies and new frontiers. Crit Care Clin. 2014
Patel NY, et al Focused assessment with sonography for trauma: methods, accuracy, and indications Surg Clin North Am. 2011
Daniel K. Does This Adult Patient Have a Blunt Intra-abdominal Injury? JAMA. 2012
Kirkpatrick AW, et al. Cost-effective remote iPhone-teathered telementored trauma telesonography. J Trauma. 2010
Nunez, et al. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? J Trauma. 2009
Ferrada, P et al. Findings of a randomized controlled trial using limited transthoracic echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay. J Trauma Acute Care Surg. 2014
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FIN