Transcript 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
 Anterior lung apices for pneumothorax
Indications
 Blunt thoraco-abdominal trauma
 Unexplained hypotension
 Trauma in pregnancy
Key Questions
 Is there FREE FLUID present?
 In the pericardial space
 In the peritoneal cavity
 In the pleural space
 Is there a PNEUMOTHORAX?
Advantages





Rapid
Reproducible
Non-invasive
Portable
No radiation or contrast
Disadvantages
 Difficult to distinguish
 Type of fluid
 Solid organ injury
 Cannot evaluate retroperitoneum
 Difficult in the obese patient
Algorithm
Blunt Thoraco-abdominal Trauma
Hemodynamically Stable
Hemodynamically Unstable
Peritoneal Signs
Ultrasound
Free Fluid/Organ Injury
Laparotomy
Ultrasound
Free Fluid/Organ Injury
Laparotomy
CT Scan
Laparotomy
Repeat U/S
CT Scan
Technique
Intraperitoneal Fluid Flow
Technique
 Low frequency probe
 2.5 – 5.0 MHz
 Tissue penetration
Sub-xiphoid
Pericardial Fluid
Pericardial Effusion
Hepato-renal Recess
 Trendelenburg position
 Anterior axillary line
Hepato-renal Fluid
Right Lung Base
 Move probe cephalad
Spleno-renal Recess
Spleno-renal Fluid
Left Lung Base
 Move probe cephalad
Pelvis
Pelvic Free Fluid
Technique
Lung Scanning for Pneumothorax
“Bat” Sign
Comet tails
Normal Lung
Pneumothorax
Pitfalls






Scan all quadrants
Repeating scans
Inferior poles
Solid organ injuries
Fat
Retroperitoneum
After a short training program, physicians can use
FAST in early assessment of trauma patients with
sufficient specificity to expedite decision making.
 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.
Questions?