Journal of Medical Ultrasound

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

Focused assessment with sonography for trauma


Pei-Hsiu Wang1, Hao-Yang Lin1, Po-Yuan Chang2, Wan-Ching Lien3,  
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

Correspondence Address:
Wan-Ching Lien
Department of Emergency Medicine, National Taiwan University Hospital, Taipei
Taiwan




How to cite this article:
Wang PH, Lin HY, Chang PY, Lien WC. Focused assessment with sonography for trauma.J Med Ultrasound 2021;29:151-153


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 Dec 4 ];29:151-153
Available from: http://www.jmuonline.org/text.asp?2021/29/3/151/326006


Full Text



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



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



Abdominal probe (with 2.5–5.0 MHz Convex transducer)

 Manipulation



Sonographic images

Assessment of right upper abdomen [1 in [Figure 1] and [Figure 3], Morison's pouch]Assessment of left upper abdomen [2 in [Figure 1] and [Figure 4], Splenorenal recess]Assessment of pelvic cavity [3 in [Figure 1] and [Figure 5], pelvic view]Assessment of pericardial sac [4 in [Figure 1] and [Figure 6], subxiphoid view]Assessment of hemothorax [5 and 6 in [Figure 2] and [Figure 7], costophrenic space]Assessment of pneumothorax [7 and 8 in [Figure 2] and [Figure 8], anterior chest]{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}{Figure 7}{Figure 8}

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}

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

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5Lien 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.
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