Ultrasound in Emergency Dept. FAST

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Ultrasound in Emergency Dept. FAST

  1. 1. FOCUSED ASSESSMENTSONOGRAPHY FOR TRAUMA FAST- EFAST Abdel H Noureldin program director Chairman scientific committee Emirates society of Emergency Medicine Tawam hospital Emergency Medicine residency program ICEM – December -2012
  2. 2. 29 Y/O male hit by a car B/P 70/20, P = 140, RR IS 50
  3. 3. given 4000 ML of LR2 units of (O positive) with no change in vitals
  4. 4. Anechoic structures
  5. 5. hyperechoic structures
  6. 6. Hypoechoic structures
  7. 7. acoustic shadow structures
  8. 8. ?
  9. 9. CURVED , LINEAR & PHASE
  10. 10. Looking at 1mm section of the body
  11. 11. Fast scan + scan at 250 ml of fluid In the abdomen. Survival was better in the FAST group. DPL decreased by 13%. CT decreased by 30%. Cost saving was about $450,000.
  12. 12. ATLS RECOMMEND FAST OR DPL
  13. 13. Fast scan for hemothoraxUS was more sensitive than chest x-ray.Faster than chest x-ray ( 1.3 vs. 14.2 min)
  14. 14. FAST SCAN FOR PNEUMOTHORAXULTRASOUND ISMORE SENSITIVE THAN CHEST X-RAY
  15. 15. CHEST, October , 2011Zhang et al pooled 20 studies that compared ultrasound, chest X-ray, or both against a reference standard (usually CT scan) for the diagnosis of pneumothorax. Chest X-ray had a pooledsensitivity of 52% and specificity 99% for diagnosis of pneumothorax. Ultrasound’s pooled sensitivitywas 88% and specificity, 100%.
  16. 16. Annals of Emergency MedicineVolume 50, Issue 3, Supplement , Pages S107-S108, September 2007 Adhikari S., Zeger W., Lomneth C., Meza J.A total of 84 ultrasound examinations were performed, 42 with the“normal lung,” and 42 with the “pneumothorax.” A sliding lung sign was correctly identified in 39 scans, and the seashore sign was correctly identified in 34 scans. THE SENSITIVITY AND SPECIFICITY FOR THE SLIDING LUNG SIGN WAS 93% (95% CI 85-100%) AND 90% (95% CI 81-99%), RESPECTIVELY. The sensitivity and specificity for the seashore sign was 80% (95% CI 68-92%), and 83% (95% CI 72-94%), respectively. The average time to complete the B-mode scan was 33 seconds, and the average time to complete the M-mode scan was 22 second
  17. 17. Am Surg. 2011 Apr;77(4):480-4. Nagarsheth K, Kurek S.Department Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA. Khanjan.Nagarsheth@gmail.com 79 patients there were 22 positive pneumothorax found by CT and of those 18 (82%) WERE FOUND ON ULTRASOUND AND 7 (32%)WERE FOUND ON CHEST X-RAY. THE SENSITIVITY OF THORACIC ULTRASOUND WAS FOUND TO BE 81.8 PER CENT AND THESPECIFICITY WAS FOUND TO BE 100 PER CENT. THE SENSITIVITY OF CHEST X-RAY WAS FOUND TO BE 31.8 PER CENT AND AGAINTHE SPECIFICITY WAS FOUND TO BE 100 PER CENT. The negativepredictive value of thoracic ultrasound for pneumothorax was 0.934 and the negative predictive value for chest X-ray for pneumothorax was found to be 0.792. We advocate the use of chest ultrasound for detection of pneumothorax in trauma patients.
  18. 18. CASES
  19. 19. 20 y/o was involved in a fighthe was stabbed in the upper back.
  20. 20. backwards Seatbelt Vid.mpeg
  21. 21. Thank you

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