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Table of Contents
EDUCATIONAL FORUM
Year : 2021  |  Volume : 29  |  Issue : 3  |  Page : 151-153

Focused assessment with sonography for trauma


1 Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
2 General Medicine Training and Demonstration Center; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
3 Department of Emergency Medicine; General Medicine Training and Demonstration Center, National Taiwan University Hospital, Taipei, Taiwan

Date of Submission12-May-2021
Date of Decision20-May-2021
Date of Acceptance22-May-2021
Date of Web Publication14-Sep-2021

Correspondence Address:
Wan-Ching Lien
Department of Emergency Medicine, National Taiwan University Hospital, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmu.jmu_128_21

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How to cite this article:
Wang PH, Lin HY, Chang PY, Lien WC. Focused assessment with sonography for trauma. J Med Ultrasound 2021;29:151-3

How to cite this URL:
Wang PH, Lin HY, Chang PY, Lien WC. Focused assessment with sonography for trauma. J Med Ultrasound [serial online] 2021 [cited 2021 Oct 27];29:151-3. Available from: http://www.jmuonline.org/text.asp?2021/29/3/151/326006



A 75-year-old female without a past medical history crashed into the change box in bus at an emergency brake when taking a bus this morning. The chief complaint was right side upper abdominal pain. Her vital sign on arrival was as follows: blood pressure of 124/73 mmHg, respiratory rate of 22/min, pulse of 103 beats per minute, and oxygen saturation of 99%. The chest X-ray demonstrated no rib fractures, pneumothorax, or hemothorax. However, physical examinations showed tenderness and bruise in right side bottom ribs.

As for the assessment of trauma patients, sonography is also important for diagnosis besides understanding the detailed mechanism of injury and complete physical examination.[1] We can use Focused Assessment of Sonography for Trauma (FAST) as an adjunct to primary survey.[2]


  Goal of Focused Assessment of Sonography for Trauma Top


  • Whether the patient has internal bleeding in abdomen?
  • Whether the patient has pericardial effusion?
  • Whether the patient has pneumothorax?
  • Whether the patient has hemothorax?



  Selection of Probe Top


  • Abdominal probe (with 2.5–5.0 MHz Convex transducer)



  Manipulation Top


Sonographic images

  1. Assessment of right upper abdomen [1 in [Figure 1] and [Figure 3], Morison's pouch]
  2. Assessment of left upper abdomen [2 in [Figure 1] and [Figure 4], Splenorenal recess]
  3. Assessment of pelvic cavity [3 in [Figure 1] and [Figure 5], pelvic view]
  4. Assessment of pericardial sac [4 in [Figure 1] and [Figure 6], subxiphoid view]
  5. Assessment of hemothorax [5 and 6 in [Figure 2] and [Figure 7], costophrenic space]
  6. Assessment of pneumothorax [7 and 8 in [Figure 2] and [Figure 8], anterior chest]
Figure 1: Focused Assessment of Sonography for Trauma assessment of free fluid in abdomen (1–3) and pericardial effusion (4)

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Figure 2: Extended Focused Assessment of Sonography for Trauma (e Focused Assessment of Sonography for Trauma). Assessment of hemothorax (5 and 6) or pneumothorax (7 and 8) in addition to basic Focused Assessment of Sonography for Trauma assessment (1–4)

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Figure 3: Place the probe parallel to the midaxillary line and then move to the bottom of the right ribs. Check whether there is effusion at the junction of the liver and kidney

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Figure 4: Place the probe parallel to the midaxillary line and then move to the bottom of the left ribs. Check whether there is effusion at the junction of the spleen and kidney

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Figure 5: Place the probe above the pubic and swept in transverse and longitudinal directions. Check whether there is effusion in the posterior side of the bladder

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Figure 6: Place the probe horizontally at the bottom of the xiphoid process of the sternum then scan toward the cranial side of the patient. Check whether there is pericardial effusion

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Figure 7: Place the probe parallel to the midaxillary line and then at the border of the ribs at both sides. Check whether there is effusion above the diaphragm

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Figure 8: Check whether there is lung sliding sign by two dimensional image or barcode sign (right panel) by M-mode image in the lungs

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The sonographic image of this case [Figure 9] showed effusion was found in Morison's pouch. The computed tomography showed hepatic laceration. The bleeding was successfully stopped after an emergent transcatheter arterial embolization.
Figure 9: Effusion at Morrison's pouch. The computed tomography showed hepatic laceration. The bleeding was successfully stopped after an emergent transcatheter arterial chemoembolization

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FAST is categorized into integrated sonography. There are many advantages for trauma patient assessment by FAST including rapidness, easy execution at bedside, noninvasion, no concern of radiation, and repeatable scanning. Hence, more and more clinicians consider FAST important. However, FAST also has the following limitations: (1) the evaluation of early abdominal bleeding and the differentiation between ascites and bleeding is operator dependent; (2) difficult manipulation in patients with obesity due to heavy subcutaneous fat; (3) less sensitivity to posterior abdominal bleeding; and (4) no visualized images in patients with traumatic subcutaneous emphysema. Literatures indicate that the sensitivity of FAST is 69%–98% in the detection of free liquid, but only 63% of solid organ injury, whereas the specificity in both is up to 94%–100%.[3] Given that the conditions of clinical trauma patients may change immediately, taking the advantage of FAST in repeated scanning will improve the sensitivity of examination.

Point-of-care ultrasound, which is developing fast in recent years, encourages the first-line physicians to answer clinical questions quickly and precisely with ultrasound. The advance of ultrasound is just like stethoscope in the 21st century, providing clinical specialties more information about organic structure and the related pathology besides medical history inquiry and physical examination.[4] More and more literatures show that, besides the application in trauma patients, FAST is also applied in nontraumatic patients such as those with shock or cardiac arrest.[5],[6] It helps intensivists with cause detection in short time and improve the accuracy of diagnosis.

Declaration of patient consent

The authors certify that they have obtained appropriate patient consent form. In the form, the patient has given his consent for the images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, et al. Focused Assessment with Sonography for Trauma (FAST): Results from an international consensus conference. J Trauma 1999;46:466-72.  Back to cited text no. 1
    
2.
Griffin XL, Pullinger R. Are diagnostic peritoneal lavage or focused abdominal sonography for trauma safe screening investigations for hemodynamically stable patients after blunt abdominal trauma? A review of the literature. J Trauma 2007;62:779-84.  Back to cited text no. 2
    
3.
Lingawi SS, Buckley AR. Focused abdominal US in patients with trauma. Radiology 2000;217:426-9.  Back to cited text no. 3
    
4.
Feilchenfeld Z, Kuper A, Whitehead C. Stethoscope of the 21st century: Dominant discourses of ultrasound in medical education. Med Educ 2018;52:1271-87.  Back to cited text no. 4
    
5.
Lien WC, Hsu SH, Chong KM, Sim SS, Wu MC, Chang WT, et al. US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: Validation and potential impact. Resuscitation 2018;127:125-31.  Back to cited text no. 5
    
6.
Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology 2017;283:30-48.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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