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Emergency Ultrasound in Trauma

Emergency Ultrasound in Trauma. Fahad Khan, MD St. Luke’s/Roosevelt Hospital Center Columbia University, New York City April 24, 2009. E -FAST. Focused Assessment with Sonograghy for Trauma Cardiac RUQ LUQ Pelvis Extended Lung bases for pleural fluid

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Emergency Ultrasound in Trauma

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  1. Emergency Ultrasound in Trauma Fahad Khan, MD St. Luke’s/Roosevelt Hospital Center Columbia University, New York City April 24, 2009

  2. E-FAST • Focused Assessment with Sonograghy for Trauma • Cardiac • RUQ • LUQ • Pelvis • Extended • Lung bases for pleural fluid • Anterior lung apices for pneumothorax

  3. Indications • Blunt thoraco-abdominal trauma • Unexplained hypotension • Trauma in pregnancy

  4. Key Questions • Is there FREE FLUID present? • In the pericardial space • In the peritoneal cavity • In the pleural space • Is there a PNEUMOTHORAX?

  5. Advantages • Rapid • Reproducible • Non-invasive • Portable • No radiation or contrast

  6. Disadvantages • Difficult to distinguish • Type of fluid • Solid organ injury • Cannot evaluate retroperitoneum • Difficult in the obese patient

  7. Blunt Thoraco-abdominal Trauma Hemodynamically Stable Hemodynamically Unstable Peritoneal Signs Ultrasound Free Fluid/Organ Injury Laparotomy Ultrasound Free Fluid/Organ Injury Laparotomy Repeat U/S CT Scan Laparotomy CT Scan Algorithm

  8. Technique

  9. Intraperitoneal Fluid Flow

  10. Technique • Low frequency probe • 2.5 – 5.0 MHz • Tissue penetration

  11. Sub-xiphoid

  12. Pericardial Fluid

  13. Pericardial Effusion

  14. Hepato-renal Recess • Trendelenburg position • Anterior axillary line

  15. Hepato-renal Fluid

  16. Right Lung Base • Move probe cephalad

  17. Spleno-renal Recess

  18. Spleno-renal Fluid

  19. Left Lung Base • Move probe cephalad

  20. Pelvis

  21. Pelvic Free Fluid

  22. Technique

  23. Lung Scanning for Pneumothorax “Bat” Sign Comet tails

  24. Normal Lung

  25. Pneumothorax

  26. Pitfalls • Scan all quadrants • Repeating scans • Inferior poles • Solid organ injuries • Fat • Retroperitoneum

  27. After a short training program, physicians can use FAST in early assessment of trauma patients with sufficient specificity to expedite decision making.

  28. Increased physician ultrasound experience is associated with increased physician accuracy in FAST examinations. • This can directly lead to a reduction in the use of CT scans, and ultimately, medical costs.

  29. Questions?

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