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Fast by nurses ppt.


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Fast by nurses ppt.

  1. 1. A Prospective evaluation of “focused assessment withsonography for trauma” done by Emergency Nurses and its comparative analysis with radiologists performance in identifying fluid during initial resuscitation of trauma Bhoi S,SoniaChauhan, Geeta A,Shakuntla , Shoukkathali V,Sinha Tej P, RK. Ramchandani Deptt. of Emergency Medicine,J P N Apex Trauma Center,AIIMS
  2. 2. Background Ultrasound has been used in the early assessment of abdominal trauma. Emergency Ultrasound (EUS) helps the treating clinician to identify emergent conditions thus facilitating the rapid diagnosis and treatment of critically ill patients Point of care sonography training to Emergency Nurses in India would facilitate multiple skill hands especially in mass casualty incidents.
  3. 3. Objective To determine the accuracy of emergency nurses in detecting free fluid in abdomen when compared to radiologist during primary survey of trauma victims by focused assessment with Sonography for trauma [FAST] scan in the Emergency Department [ED].
  4. 4. METHODOLOGY• Study design- Qualitative prospective study• Performance centre - ED of JPN Apex Trauma Centre, AIIMS.• Study duration-January to September 2011
  5. 5.  The study subjects included emergency Nurses (EN) who underwent training at 3-day workshop on emergency sonography They performed 10 supervised positive and negative scans for free fluid. The FAST scans were first performed by the EN’s and then by radiology resident (RR). Both were blinded to each other’s sonography findings. CT scan and laparotomy findings were used as gold standard whichever was feasible. Results were compared between both groups.
  6. 6. FAST  Focused  Assessment by  Sonography in  Trauma AUTLS
  7. 7. FAST scan Minimal amount of fluid in abdomen detectable by USG ~ 200 - 650ml High sensitivity in detecting hemoperitoneum (63 -100% ) High specificity in detecting hemoperitoneum (96 - 99%)100%) Low sensitivity in detecting specific organ lesions (<50%)
  8. 8. FAST Exam- Primary Views orWindows1. Subxiphoid2. Right upper quadrant (RUQ)3. Left upper quadrant (LUQ)4. Suprapubic
  9. 9. FAST Exam - RUQ
  10. 10. FAST Exam - LUQ
  11. 11. FAST Exam – Supra-pubic Transverse view
  12. 12. Results 94 scans performed each by EN and RR were analysed. Mean age of the patients was 29 [2 - 85] years. Out of 23 true positive patients 18 underwent CT scan and exploratory laparotomy was done in 14 patients. Sensitivity of FAST done by EN and RR was 90 %. Specificity of FAST done by EN was 94.6 %Vs RR. Positive predictive value and negative predictive values were 81.8% and 97.2% respectively
  13. 13.  Limitation: Inter-observer variability was not noted
  14. 14. FAST: Strengths and LimitationsStrengths Limitations Rapid (~2 mins)  Does not typically identify Portable source of bleeding, or detect Inexpensive injuries that do not cause hemoperitoneum Technically simple, easy to  Requires extensive training train (studies show to assess parenchyma competence can be achieved reliably after ~30 studies)  Limited in detecting <250 cc Can be performed serially intraperitoneal fluid Useful for guiding triage  Particularly poor at detecting decisions in trauma patients bowel and mesentery damage (44% sensitivity)  Difficult to assess retroperitoneum  Limited by habitus in obese patients
  15. 15. Conclusion FAST scan performed by EN who are trained in short course of ultrasonography can be reliable and accurate when comparable to qualified radiologist. It can be helpful during crisis scenarios e.g. Mass casualty incidents.