Focused Assessment With Sonography For Trauma Exam Research Articles

The Impact of a Student-Taught Point-of-Care Ultrasound Workshop on Confidence in Medical and Pre-Medical Students

Background: The vast utilization of Point-of-Care Ultrasound (POCUS) across medical specialties has increased the need for enhanced undergraduate medical education in image acquisition and interpretation among medical students. However, challenges such as the need for a standardized medical school curriculum and limited trained faculty preceptors restrict its implementation. The literature highlights the potential of student-taught POCUS workshops in expanding access and enhancing learning. This study seeks to evaluate the efficacy of a student-run POCUS workshop for medical and pre-medical students. Methods: A prospective, cross-sectional study assessed the efficacy of first and second-year medical students teaching a POCUS workshop on the Focused Assessment with Sonography for Trauma (FAST) exam. Student workshop participants were asked to complete pre- and post-workshop surveys to assess their confidence in utilizing POCUS and identifying relevant organs and landmarks. Surveys employed a standardized five-point Likert Scale. Results: Of the 43 initial participants, 29 completed both surveys. Results showed a significant increase in self-reported ultrasound experience (1.7 to 3.2, p < 0.001) and confidence in performing the FAST exam and organ identification (2.2-fold increase, p < 0.001). Both medical and pre-medical student cohorts exhibited similar confidence improvements in confidence. Conclusion: This study supports the literature that student-taught POCUS programs may be a viable adjunct to an institution's ultrasound curriculum. Implementing medical student-led workshops could help address current training gaps, enhance students' teaching and leadership skills, and improve confidence in utilizing and interpreting ultrasound images.

Who Says You can't go FAST at Night? Use of a Novel Ultrasound-Capable Night Vision Device for Prehospital Medical Personnel to Identify Noncompressible Truncal Hemorrhage.

Early detection of abdominal hemorrhage via ultrasound has life-saving implications for military and civilian trauma. However, strict adherence to light discipline may prohibit the use of ultrasound devices in the deployed setting. Additionally, current night vision devices remain noncompatible with ultrasound technology. This study sought to assess an innovative night vision device with ultrasound capable picture-in-picture display via a intraabdominal hemorrhage model to identify noncompressible truncal hemorrhage in blackout conditions. 8 post mortem fetal porcine specimens were used and divided into 2 groups: intrabdominal hemorrhage (n = 4) vs no hemorrhage (n = 4). Intrabdominal hemorrhage was modeled via direct injection of 200mL of normal saline into the peritoneal cavity. Under blackout conditions, 5 participants performed a focused assessment with sonography for trauma (FAST) exam on each model using the prototype ultrasound-capable night vision device. Of the 40 FAST exams performed, 95% (N = 38) resulted in the correct identification of intraabdominal hemorrhage. Of the incorrectly identified exams, both were false positives resulting in a 100% sensitivity, 90% specificity, 91% positive predictive value, and a 100% negative predictive value. All participants noted the novel device was easy to use and provided superior visualization for performing FAST exams under blackout conditions. The ultrasound-enabled night vision prototype demonstrated promising results in identifying noncompressible truncal hemorrhage while maintaining strict light discipline in blackout conditions. Further research efforts should be directed at assessing the ability of providers to perform procedures in blackout conditions using the ultrasound-enabled prototype night vision device.

Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition.

Over the past twenty years, the Focused Assessment with Sonography for Trauma (FAST) exam has transformed the care of patients presenting with a combination of trauma (blunt or penetrating) and hypotension. In these hemodynamically unstable trauma patients, the FAST exam permits rapid and noninvasive screening for free pericardial or peritoneal fluid, the latter of which implicates intra-abdominal injury as a likely contributor to the hypotension and justifies emergent abdominal surgical exploration. Further, the abdominal portion of the FAST exam can also be used outside of the trauma setting to screen for free peritoneal fluid in patients who become hemodynamically unstable in any context, including after procedures that may inadvertently injure abdominal organs. These "non-trauma" situations of hemodynamic instability are often triaged by providers from specialties other than emergency medicine or trauma surgery who are not familiar with the FAST exam. Therefore, there is a need to promulgate knowledge about the FAST exam to all clinicians caring for critically ill patients. Toward this end, this article describes FAST exam image acquisition: patient positioning, transducer selection, image optimization, and exam limitations. Since the free fluid is likely to be found in specific anatomic locations that are unique for each canonical FAST exam view, this work centers on the unique image acquisition considerations for each window: subcostal, right upper quadrant, left upper quadrant, and pelvis.

Investigating the Skill Development of Medical Students in Focused Assessment With Sonography for Trauma (FAST) Ultrasound: A Comparative Analysis Across Different Stages of Medical Training.

Focused assessment with sonography for trauma (FAST) ultrasound (US) is a valuable medical examination used in trauma settings, particularly for rapid responses to events such as natural disasters. Although the efficacy and benefits of FAST in patient care have been extensively studied, there is limited research on training medical students in FAST. Previous studies have found that medical students can proficiently perform a FAST US after two days of training. However, these studies exclusively included first-year medical students without considering variations in their medical knowledge. Particularly, the advantage of medical students having US experience before undergoing FAST training has not been previously examined. Assess the performance and knowledge acquisition of medical students with and without prior US experience after completing a FAST training course. The study included a total of 71 students, consisting of 33 males and 38 females, who were between the ages of 18 and 31, with an average age of 24.6 and a standard deviation of 2.4. The inclusion criteria targeted first- and second-year medical school students who participated on a volunteer basis. Students were divided into two groups: group A, consisting of those without prior USexperience, and group B, made up of those who had previous US experience. All students completed a pre-training survey to share their comfort and confidence in US use and knowledge. A baseline FAST exam was conducted to establish initial performance. A comprehensive three-hour training session was then provided. Post-training, students performed another FAST exam to assess improvement, followed by a post-training survey to evaluate comfort and confidence. Medical students who had prior experience in the US (group B) performed significantly better (p<0.01) in both the pre- and post-training FAST exams when compared to students without previous US experience. Specifically, in locating the liver, right kidney, hepatorenal recess, and left kidney, as well as detecting fluid accumulation when in a supine position. Additionally, medical students with prior US experience (group B) exhibited higher baseline confidence (p<0.005-p<0.01) in their ability to perform a FAST exam, as indicated by the results of the pre-testing survey. Previous experience with USsignificantly boosted confidence and knowledge gains following FAST training. This emphasizes the value of including US training in medical school programs after earlier exposure, offering evident benefits. The study reveals the unexplored benefit of having prior US experience for medical students undergoing FAST training, thus addressing a previously unexplored area in current research. The conclusions stress the necessity of integrating US training into medical school curricula after initial exposure. This understanding can direct medical educators in refining the education process, enabling students to be better equipped for real-world medical situations involving FAST.

Implanted Penile Prosthetic Visualized During Focused Assessment with Sonography for Trauma Examination: A Case Report.

This is a case report of an implanted penile prosthetic visualized during focused assessment with sonography for trauma (FAST) examination. The case represents a unique finding near the lateral bladder that may confound assessment of intraperitoneal fluid collections during initial assessment of trauma patients. A 61-year-old Black male was brought to the emergency department from a nursing facility for evaluation after sustaining a ground-level fall. A FAST exam demonstrated an abnormal fluid collection anterior and lateral to the bladder, later identified as an implanted penile prosthetic. Focused assessment with sonography for trauma examinations are often performed on unidentified patients in a time-sensitive manner. Understanding of potential false-positive results is crucial to appropriate use of the tool. This report demonstrates a novel false-positive result that may be difficult to differentiate from a true intraperitoneal bleed.

Anatomy Education Elective: A Model for Vertical Integration and Self‐Directed Learning in the Medical Curriculum

INTRODUCTIONWith decreased curricular time devoted to anatomy courses, it is imperative that medical students have opportunities to review anatomical content in the clinical years. Vertical integration of anatomy into the clinical curriculum facilitates the transfer of anatomical knowledge from the classroom to the clinic by providing concrete examples that illustrate the clinical relevance of anatomical content. The Liaison Committee on Medical Education (LCME) also requires that medical schools provide students with opportunities to engage in self‐directed learning to cultivate the habits of lifelong learning.OBJECTIVESTo discuss the effectiveness of a 4th year Anatomy Education elective for integrating anatomy into the clinical curriculum and engaging students in self‐directed learning.DESCRIPTIONIn 2016 an Anatomy Education elective was introduced at Indiana University School of Medicine to provide 4th year medical students with an opportunity to revisit an anatomical topic during the clinical years by developing an educational module that integrates anatomical knowledge with clinical applications. The anatomy education elective is also an opportunity for 4th year students to engage in self‐directed learning on an anatomical topic that aligns with their area of clinical interest. The elective entails students generating learning objectives that their module will address, creating module content in a format of their choosing, and developing an appropriate assessment for the module. Students are encouraged to approach an anatomical topic from a clinical perspective to illustrate the clinical relevance of the anatomical structures and relationships. Twenty‐six student have taken the Anatomy Education elective as of 2021. Some examples of module topics include a review of hepatic anatomy and histology using a clinical case of portal hypertension and placement of a trans‐jugular intrahepatic portosystemic shunt; a review of abdominal anatomy through the lens of a the FAST (Focused Assessment with Sonography for Trauma) exam; and a review of facial anatomy in the context of a facial nerve injury and facial re‐animation procedure.OBSERVATIONSStudents’ experiences during the Anatomy Education elective have been overwhelmingly positive. Student feedback confirms that the elective engaged their self‐directed learning skills, and they appreciated the opportunity to explore a topic of interest. Some student comments include: “I really appreciated the flexibility that this elective allowed. I learned a great deal and was given autonomy when selecting my project topic and content. [The professor] provided excellent guidance and feedback while also allowing me, as the student, to take ownership of my project” and “I enjoyed getting to conduct independent learning about a topic of my choice. I was able to dedicate time to learning about the eye, a topic that I did not feel very confident about after first‐ and second‐year curriculum.”CONCLUSIONSThe Anatomy Education elective is an effective way to vertically integrate gross anatomy into the clinical curriculum. Student feedback confirms that the elective engaged their self‐directed learning skills and the autonomy to choose their own topic motivated students to take ownership of their project.

Point-of-Care Ultrasound in Trauma: More Than a FAST Exam

Features| March 2022 Point-of-Care Ultrasound in Trauma: More Than a FAST Exam Laura Girón-Arango, MD; Laura Girón-Arango, MD Search for other works by this author on: This Site PubMed Google Scholar Marcos Silva Restrepo, MD, MSc, FRCPC, FASE; Marcos Silva Restrepo, MD, MSc, FRCPC, FASE Search for other works by this author on: This Site PubMed Google Scholar Pablo Pérez d'Empaire, MD, FRCPC, FCCM, FASE Pablo Pérez d'Empaire, MD, FRCPC, FCCM, FASE Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor March 2022, Vol. 86, 31–32. https://doi.org/10.1097/01.ASM.0000823092.52893.e9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Laura Girón-Arango, Marcos Silva Restrepo, Pablo Pérez d'Empaire; Point-of-Care Ultrasound in Trauma: More Than a FAST Exam. ASA Monitor 2022; 86:31–32 doi: https://doi.org/10.1097/01.ASM.0000823092.52893.e9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: focused assessment with sonography of trauma, point-of-care ultrasonography, wounds and injuries, ultrasonography Point-of-care ultrasound (POCUS) in trauma was introduced early with the Focused Assessment with Sonography for Trauma (FAST) exam, a well-known scanning protocol incorporated into the Advanced Trauma Life Support® program to help with the diagnosis of life-threatening situations during the primary survey. The original FAST exam included four views: right and left upper quadrant, suprapubic, and subxiphoid (pericardial). The FAST protocol now includes the examination of the chest to assess for pneumothorax, now known as the Extended FAST (E-FAST). More recently, POCUS has moved well beyond the E-FAST, providing potential value for diagnosis and management of trauma patients (Semin Ultrasound CT MR 2018;39:374-83). We will focus on the more novel applications for upper-airway and gastric exams as well as resuscitation transesophageal echocardiography (TEE). Upper-airway ultrasound is a quick, non-invasive, and reliable tool to enhance the management of the airway in situations when the anatomy can be altered... You do not currently have access to this content.

Focused assessment with sonography for trauma in predicting early surgical intervention in hemodynamically unstable children with blunt abdominal trauma.

ObjectivesThe predictive accuracy and clinical role of the focused assessment with sonography for trauma (FAST) exam in pediatric blunt abdominal trauma are uncertain. This study investigates the performance of the emergency department (ED) FAST exam to predict early surgical intervention and subsequent free fluid (FF) in pediatric trauma patients.MethodsPediatric level 1 trauma patients ages 0 to 15 years with blunt torso trauma at a single trauma center were retrospectively reviewed. After stratification by initial hemodynamic (HD) instability, the association of a positive FAST with (1) early surgical intervention, defined as operative management (laparotomy or open pericardial window) or angiography within 4 hours of ED arrival and (2) presence of FF during early surgical intervention was determined.ResultsAmong 508 salvageable pediatric trauma patients with an interpreted FAST exam, 35 (6.9%) had HD instability and 98 (19.3%) were FAST positive. A total of 42 of 508 (8.3%) patients required early surgical intervention, and the sensitivity and specificity of FAST predicting early surgical intervention were 59.5% and 84.3%, respectively. The specificity and positive predictive value of FF during early surgical intervention in FAST‐positive HD unstable patients increased from 50% and 90.9% at 4 hours after ED arrival to 100% and 100% at 2 hours after ED arrival, respectively.ConclusionsIn this large series of injured children, a positive FAST exam improves the ability to predict the need for early surgical intervention, and accuracy is greater for FF in HD unstable patients 2 hours after arrival to the ED.

1136 The FAST exam in obstetrics: a feasibility study

The Focused Assessment with Sonography for Trauma (FAST) exam, is a point of care ultrasound evaluation used routinely in surgical and trauma evaluation of critically ill patients to assess intrabdominal free fluid. It is a cost effective, noninvasive approach with no radiation exposure, which allows for rapid decision making in surgical intervention. Although extensively evaluated in the trauma and critical care literature, this study has never been evaluated in an obstetric population. Our objective was to create an ultrasound training protocol and evaluate the feasibility of this study during pregnancy. This is a prospective, observational study completed in large academic center. Health care providers (sonographers and physicians) underwent an ultrasound training protocol involving a live webinar and on-site supervision to obtain the four standard FAST exam views (the right upper quadrant, left upper quadrant, subcostal cardiac, and pelvis). Patients were enrolled after their routine obstetric ultrasound evaluation and additional images for the FAST exam were completed. The images were then reviewed for quality by a blinded physician subspecialist in clinician performed ultrasound and critical care echocardiography. 64 ultrasound studies were completed each evaluating standard FAST exam views. 62/64 (96.8%) of exams had adequate visualization of all windows. Fisher exact test was completed and no significant differences in visualization across gestational age between early pregnancy (24 weeks) , or BMI were noted (P<0.05). The FAST exam is a feasible study among pregnant women, it is not affected by gestational age or BMI. Training of obstetric providers with a web-based ultrasound protocol and quality review of images demonstrates the ability of clinicians familiar with obstetric ultrasound the ability to complete the FAST exam successfully. This is a novel study, suggesting the FAST exam may serve as a useful clinical adjunct during assessment of critically ill obstetric patients.

Test characteristics of focused assessment with sonography for trauma (FAST), repeated FAST, and clinical exam in prediction of intra-abdominal injury in children with blunt trauma.

In children with blunt abdominal trauma (BAT), focused assessment of sonography in trauma (FAST) has been reported with low sensitivity, on the whole, in the detection of intra-abdominal injuries (IAI). The aim of the present study was to assess test characteristics of FAST using different strategies including repeated FAST (reFAST), and physical exam findings. This retrospective study evaluated BAT pediatric patients with stable hemodynamics who underwent computed tomography (CT). Demographic data, initial physical examination, and results of FAST, reFAST (if done), and CT imaging were recorded. Different strategies of FAST were cross-tabulated with CT as the gold standard and test characteristics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were interpreted. 129 patients with a mean age of 8.6 ± 4.7 were studied and 74% were male. Comparing CT-positive and -negative groups, from the demographic and clinical findings, only positive physical exam (tenderness or ecchymosis) was significantly higher in the CT-positive group (59% vs. 17%; p < 0.01). In a multivariate analysis, positive FAST modality and clinical exam remained independent predictors for a positive CT result (likelihood ratios of 34.6 and 6.4, respectively). Out of the different diagnostic strategies for the prediction of IAI, the best overall performance resulted from the FAST-reFAST-tenderness protocol with sensitivity, specificity, PPV, NPV, and accuracy of 87%, 77%, 70%, 91%, and 81%. For children with blunt abdominal trauma, physical examination plus FAST and reFAST as needed, seems to have reasonable sensitivity, specificity, and accuracy in detecting intra-abdominal injuries and may reduce the need for CT scans.

Predicting False-Negative FAST Exams in Pediatric Abdominal Trauma

Being able to predict false-negative results of focused assessment with sonography for trauma (FAST) exams in children with blunt abdominal trauma

Lung ultrasound for detecting pneumothorax in injured children: preliminary experience at a community-based Level II pediatric trauma center.

Ultrasound (US) has been used in the adult trauma population with reported moderate to high sensitivities, but data are scarce in the pediatric trauma population. The purpose of this study was to specifically examine the sensitivity and specificity of one lung US methodology (single-point anterior exam) in the pediatric trauma population when compared to chest radiography or CT. We conducted a retrospective review of pediatric trauma patients who received lung US as an extension of the focused assessment with sonography for trauma (FAST) exam. We compared lung US findings with chest radiography and CT scans. Two hundred twenty-six pediatric trauma patients underwent lung US exam with confirmatory exams; 11 pneumothoraces (4.8%) were observed. Of those 11, 6 were evaluated as false negatives on the lung US. Analyses resulted in 45.5% sensitivity, 98.6% specificity and 96.0% accuracy. Pneumothoraces undetected by lung US were small and apical and were likely not observed because of their size and location. None of the false negatives required intervention. All true positives were associated with lung contusions. Pneumothorax is less common in the pediatric than the adult trauma population, and when encountered in children pneumothorax is often occult and might be associated with lung contusions. Existing evidence supports the usefulness of chest US in detecting pneumothorax in adults and suggests that it can be translated to injured children. However, our findings suggest that the sensitivity of lung US as a single-point anterior exam extension of the FAST exam might not be as reliable in the pediatric trauma population as in adults. Other methodologies using lung US might improve sensitivity.

Rapid, remote education for point-of-care ultrasound among non-physician emergency care providers in a resource limited setting.

IntroductionAccess to high-quality emergency care in low- and middle-income countries (LMIC) is lacking. Many countries utilise a strategy known as “task-shifting” where skills and responsibilities are distributed in novel ways among healthcare personnel. Point-of-care ultrasound (POCUS) has the potential to significantly improve emergency care in LMICs.MethodsPOCUS was incorporated into a training program for a ten-person cohort of non-physician Emergency Care Providers (ECPs) in rural Uganda. We performed a prospective observational evaluation on the impact of a remote, rapid review of POCUS studies on the primary objective of ECP ultrasound quality and secondary objective of ultrasound utilisation. The study was divided into four phases over 11 months: an initial in-person training month, two middle month blocks where ECPs performed ultrasounds independently without remote electronic feedback, and the final months when ECPs performed ultrasounds independently with remote electronic feedback. Quality was assessed on a previously published eight-point ordinal scale by a U.S.-based expert sonographer and rapid standardised feedback was given to ECPs by local staff. Sensitivity and specificity of ultrasound exam findings for the Focused Assessment with Sonography for Trauma (FAST) was calculated.ResultsOver the study duration, 1153 ultrasound studies were reviewed. Average imaging frequency per ECP dropped 61% after the initial in-person training month (p = 0.01) when ECPs performed ultrasound independently, but rebounded once electronic feedback was initiated (p = 0.001), with an improvement in quality from 3.82 (95% CI, 3.32–4.32) to 4.68 (95% CI, 4.35–5.01) on an eight-point scale. The sensitivity and specificity of FAST exam during the initial training period was 77.8 (95% CI, 59.2–83.0) and 98.5 (95% CI, 93.3–99.9), respectively. Sensitivity improved 88% compared to independent, non-feedback months whereas specificity was unchanged.ConclusionsRemotely delivered quality assurance feedback is an effective educational tool to enhance provider skill and foster continued and sustainable use of ultrasound in LMICs.

Trauma to the Abdomen and Pelvis

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs. This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

Trauma to the Abdomen and Pelvis

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs. This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

Pediatric Abdominal Trauma.

Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Nonoperative management is employed in over 95% of patients. Penetrating injuries are less common but often require operative management. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries. Computed Tomography (CT) is the gold standard in the identification of intra-abdominal injury. Focused Assessment with Sonography for Trauma (FAST) can detect the presence of free fluid suggestive of intra-abdominal injury. In children, the utility of FAST is limited because less than half of pediatric patients with abdominal injury have free fluid. Bowel perforation and pancreatic injuries may not be evident on initial CT scanning of the abdomen. Initial management of the trauma patient in shock includes fluid boluses of normal saline or Ringer's lactate with two, large-bore upper extremity catheters. Transfusion with packed red blood cells is done if the patient remains hypotensive after the second fluid bolus. Emergent laparotomy is indicated in patients with: free intraperitoneal air, hemodynamic instability despite maximal resuscitative efforts (transfusion of greater than 50% of total blood volume), gunshot wound to the abdomen or other penetrating traumas, and evisceration of intraperitoneal contents. Initial FAST followed by abdominal computed tomography is important in the evaluation of the seriously or critically injured patient. The combination of the FAST exam along with selected abdominal computed tomography can further aid in the detection of injuries that may not be clinically apparent.

Accuracy of the Fast Exam: A Retrospective Analysis of Blunt Abdominal Trauma Patients

Background: Point-of-care ultrasound (POCUS) is a vital tool for diagnosis and management of emergency room patients. Focused assessment with sonography for trauma (FAST) is a bedside ultrasound performed by clinicians in the evaluation of trauma patients. In 2012, Haroborview Medical Center, the only level-one trauma center in five northwestern states, officially incorporated emergency physician (EP) performed FAST exams for critically injured blunt abdominal trauma (BAT) patients. Objective: We sought to determine the accuracy of EP performed FAST exams for severely injured patients with blunt abdominal trauma (BAT). Secondary objectives included trends in use of diagnostic peritoneal lavage (DPL) to identify hemoperitoneum after the implementation of the new protocol. Design: We conducted a retrospective chart review using the emergency department tracking system to identify all Emergency Severity Index (ESI) 1 trauma patients with BAT over a 26-month study period (July 1, 2011 to August 31, 2013). Hemodynamically unstable BAT patients who had a FAST exam performed were included for further analysis. Results of EP FAST exams and radiology department FAST exams were compared against peritoneal fluid analysis, computed tomography results, and operative findings, where available. Results: 185 patients met inclusion criteria. In total there were 33 true positive, 109 true negative, 2 false positive, 12 false negative, and 29 indeterminate examinations, for an overall sensitivity, specificity, and accuracy of 73%, 98%, and 91% respectively. EP performed FAST exams had a sensitivity, specificity and accuracy of 88% (95% CI 67 to 96 %), 98% (95% CI 87 to 99 %), and 94% for moderate to large amounts of intra-peritoneal hemorrhage. The overall use of DPL in the evaluation of critically ill blunt trauma patient decreased slightly with the protocol change, however this decrease was not significant (p=0.17). Conclusion: Our study demonstrated that emergency physicians are accurate in identifying hemoperitoneum in critically injured BAT patients. Secondary findings suggest that utilization of DPL in hemodynamically unstable BAT patients decreased modestly

Utilisation of Focused Assessment with Sonography for Trauma (FAST) in a referral hospital in an acute conflict zone

Introduction The role of Focused Assessment with Sonography for Trauma (FAST) is well described in the literature in high-resource general emergency care settings. However, there are limited data on utilisation of FAST by local providers in limited-resource conflict settings. We describe the first experience of a hospital in E-DRC using the FAST exam in triage to evaluate and expedite blunt and penetrating trauma patients during an armed invasion. Methods HEAL Africa Hospital (HEAL) is a tertiary trauma centre located in Goma, Eastern Democratic Republic of Congo. In 2010, ultrasound training was initiated. During subsequent armed fighting and the invasion of Goma, the hospital adopted the FAST exam as triage tool in the emergency centre (EC). Ultrasound scans were prospectively logged and perceived utility for immediate patient management was recorded. At a 1year follow-up, a cohort of physician and nurses considered downstream patient recipients were also asked perceived utility towards its use. Results 222/243 (91%) of ultrasound scans were recorded by physicians as having positive utility for immediate patient management. 61/243 (25%) scans were FAST exams; 24 for obstetric evaluation and 158 were scans for pain management with ultrasound regional anaesthesia. 23/61 (41%) of the FAST were reported as positive. Patients with+FAST were immediately prioritised and either a chest tube was placed or taken to the operating room for laparotomy. All 23 patients brought for laparotomy or chest tube were shown to have haemoperitoneum or positive output respectively. Discussion The introduction of FAST training and requisite equipment in resource stressed healthcare settings is both desirable and feasible. In this study, the introduction of FAST by local providers had an important influence on the decision making process and enabled immediate triage of casualties to laparotomy, chest tube or clinical observations. Prospective controlled research is further needed to evaluate the impact.

The Role of Ultrasound in Thoracic Trauma (Aplicações Da Ultrassonografia Do Tórax: Cenário Do Trauma)

IntroductionThoracic trauma is a condition that affects mostly young people, with high rates of morbidity and mortality, demanding fast and effective treatment. Thoracic ultrasound is a useful tool in these cases, usually contributing to complement FAST (Focused Assessment with Sonography for Trauma) exam and enabling the diagnosis of several disorders that may require medical intervention.Methods InvolvedThis pictorial essay illustrates some disorders related to thoracic trauma and their imaging findings on ultrasound evaluation.DiscussionUltrasonography has the advantage of being easily accessible in different places where polytraumatized might be taken to, such as emergency rooms and intensive care unities, situations that frequently demand immediate diagnostic and therapeutic measures. Some disorders that can be diagnosed by the method are soft tissue hematomas, rib fractures, pneumothorax, hemothorax and lung consolidation. Besides its high sensitivity, the method can also assist therapeutic procedures, such as guided thoracic drainage.Conclusion of the PresentationTherefore, in evidence-based medical practice, ultrasonography plays a crucial role in thoracic trauma scene, as it’s a fast and versatile method, representing a technique that should be mastered by every radiologist. IntroductionThoracic trauma is a condition that affects mostly young people, with high rates of morbidity and mortality, demanding fast and effective treatment. Thoracic ultrasound is a useful tool in these cases, usually contributing to complement FAST (Focused Assessment with Sonography for Trauma) exam and enabling the diagnosis of several disorders that may require medical intervention. Thoracic trauma is a condition that affects mostly young people, with high rates of morbidity and mortality, demanding fast and effective treatment. Thoracic ultrasound is a useful tool in these cases, usually contributing to complement FAST (Focused Assessment with Sonography for Trauma) exam and enabling the diagnosis of several disorders that may require medical intervention. Methods InvolvedThis pictorial essay illustrates some disorders related to thoracic trauma and their imaging findings on ultrasound evaluation. This pictorial essay illustrates some disorders related to thoracic trauma and their imaging findings on ultrasound evaluation. DiscussionUltrasonography has the advantage of being easily accessible in different places where polytraumatized might be taken to, such as emergency rooms and intensive care unities, situations that frequently demand immediate diagnostic and therapeutic measures. Some disorders that can be diagnosed by the method are soft tissue hematomas, rib fractures, pneumothorax, hemothorax and lung consolidation. Besides its high sensitivity, the method can also assist therapeutic procedures, such as guided thoracic drainage. Ultrasonography has the advantage of being easily accessible in different places where polytraumatized might be taken to, such as emergency rooms and intensive care unities, situations that frequently demand immediate diagnostic and therapeutic measures. Some disorders that can be diagnosed by the method are soft tissue hematomas, rib fractures, pneumothorax, hemothorax and lung consolidation. Besides its high sensitivity, the method can also assist therapeutic procedures, such as guided thoracic drainage. Conclusion of the PresentationTherefore, in evidence-based medical practice, ultrasonography plays a crucial role in thoracic trauma scene, as it’s a fast and versatile method, representing a technique that should be mastered by every radiologist. Therefore, in evidence-based medical practice, ultrasonography plays a crucial role in thoracic trauma scene, as it’s a fast and versatile method, representing a technique that should be mastered by every radiologist.

Horizontal subxiphoid landmark optimizes probe placement during the Focused Assessment with Sonography for Trauma ultrasound exam

To introduce an external landmark for optimizing probe placement during Focused Assessment with Sonography for Trauma (FAST) exam. This prospective study was conducted in two phases. First, the students and emergency medicine residents were trained in FAST exam utilizing the horizontal subxiphoid (HS) landmark. The landmark consists of the crossing points of a horizontal line extending from the xiphoid process to the right midaxillary line (H point) and left posterior axillary line (S point). Second, the trained students and residents performed FAST among Emergency Departments patients at two teaching hospitals. The primary outcome was a target organ acquisition score for each view, derived from the number of target organs visualized on an initial probe placement. Secondary endpoints included: time required to obtain the requisite images, and the impact of patient characteristics on landmark prediction rate. Forty-eight providers performed 477 exams. The collective prediction rate of the HS landmark was 86.6% for both H and S points upon first attempt without further probe adjustments. Operators visualized all required target structures at the first probe placement site in 430 out of 477 (90.1%) cases at the right upper quadrant, and in 392 out of 474 (82.7%) cases at the left upper quadrant without further probe adjustments. Limited probe adjustment (<2 cm from the initial landmark site) improved the success rate up to 95.6 and 90% to the right upper quadrant and left upper quadrant, respectively. As BMI increased, precision score decreased and image acquisition time increased. The HS line is an external landmark that may optimize probe placement and facilitates teaching and performance of FAST examination.