Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Focused Assessment with Sonography in Trauma (FAST) in 2017

5,245 views

Published on

FAST , its definition, its modifications, its extensions in various other situations such as pregnancy, in pediatric populations, use in triage of patients. Described extended FAST which include evaulation for pneumothorax, pleural effusion, pericardial effusion. other extensions of FAST such as RUSH, RADIUS.

Published in: Health & Medicine
  • DOWNLOAD THE BOOK INTO AVAILABLE FORMAT (New Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THE can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THE is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBOOK .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, CookBOOK, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, EBOOK, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THE Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THE the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THE Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THE BOOK INTO AVAILABLE FORMAT (New Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THE can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THE is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBOOK .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, CookBOOK, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, EBOOK, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THE Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THE the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THE Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Dating for everyone is here: ❶❶❶ http://bit.ly/2ZDZFYj ❶❶❶
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Dating direct: ❶❶❶ http://bit.ly/2ZDZFYj ❶❶❶
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • ..............ACCESS that WEBSITE Over for All Ebooks ................ ......................................................................................................................... DOWNLOAD FULL PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Focused Assessment with Sonography in Trauma (FAST) in 2017

  1. 1. Focused Assessment with Sonography in Trauma (FAST) in 2017 Dr Varun Bansal Deptt of Radio-diagnosis
  2. 2. Objectives • Discuss the accuracy and utility of FAST in clinical decision making, as well as limitations and pitfalls • Describe newer protocols such as eFAST, BLUE, RADIUS, RUSH and their uses • Discuss the use of FAST in special populations such as pregnant and pediatric patients
  3. 3. • The advent of FAST , 3 decades ago enabled clinicians -  to rapidly screen for injury at the bedside of patients, especially those patients too hemodynamically unstable for transport to the CT suite  Identification of free fluid in potential spaces  Detection of solid organ injury, pneumothorax, fractures, serial examinations,  as well as use in prehospital transport and multiple casualty settings as a triage tool.
  4. 4. The Evolution of FAST • “focused abdominal sonography for trauma” • “focused assessment with sonography for trauma” • included in the Advanced Trauma Life Support program for evaluation of the hypotensive trauma patient
  5. 5. Accuracy of FAST and Clinical Decision Making • sensitivity (69%–98%) for detection of free fluid and lower sensitivity (63%) for detection of solid organ injury • underestimation of injuries and severity, especially in stable trauma patients without detectable free fluid. • high specificity (94%– 100%) for detection of free fluid and/or solid organ injury • Serial FAST examinations increase overall sensitivity (72%–93%).
  6. 6. Diagnostic algorithm for the use of FAST for triage of trauma patients. CEUS = contrast enhanced US.
  7. 7. FAST Technique and Interpretation • Probe selection • (3–5 MHz) is best utilized as a multipurpose probe. • examining solid organs and determining presence of free fluid in the abdomen or pelvis. • examine the heart for a pericardial effusion or hemorrhage. • useful to scan between the ribs for pneumothorax.
  8. 8. (a) the right upper quadrant, perihepatic area and hepatorenal recess or Morison pouch (b) the left upper quadrant, the perisplenic view (c) the suprapubic view (pouch of Douglas), (d) a subxiphoid pericardial view • The preferred initial site - free fluid with FAST - right upper quadrant view, scanned by using a lower frequency (3.5–5 MHz).
  9. 9. Limitations to the FAST • Detection of blunt mesenteric, bowel, diaphragmatic, and retroperitoneal injuries can be difficult, as well as isolated penetrating injury to the peritoneum. • False-positive scans - detection of ascites, peritoneal dialysate, ventriculo peritoneal shunt outflow, ovarian hyperstimulation, and ovarian cyst rupture. • Massive intravascular volume resuscitation  false-positive FAST examination -intravascularto- intraperitoneal fluid transudation .
  10. 10. • Free fluid detected with FAST in trauma patients is assumed to be hemoperitoneum, can also represent injury-related urine, bile, and bowel contents. • Bowel gas, subcutaneous emphysema, and obesity represent common obstacles to full US visualization. • delayed presentation after trauma  hemoperitoneum containing clots which can have mixed echogenicity and be missed
  11. 11. Newer Protocols • In the mid-2000s, the addition of US evaluation of the thorax to detect pneumothorax to the traditional FAST examination resulted in extended FAST (eFAST)
  12. 12. There are several other protocols developed for evaluation of shock, respiratory distress, and cardiac arrest, some of which feature echocardiography
  13. 13. • Other protocols for evaluation of dyspnea BLUE (bedside lung US in emergency) and RADIUS (rapid assessment of dyspnea with US). • The BLUE protocol includes only lung US for detection of pneumothoraces, as well as pulmonary edema, consolidation, and effusion . • The RADIUS protocol is similar but includes cardiac and inferior vena cava (IVC) evaluation
  14. 14. RUSH protocol • (Rapid US for Shock and Hypotension) • The “pump’ evaluation  parasternal long and short axis of the heart, plus subxiphoid and apical views. • The “tank” evaluation  IVC, FAST abdomen including pleural views, and US of the lung. • The “pipes” portion of RUSH involves scanning the suprasternal, parasternal, epigastric, and supraumbilical aorta, with additional scans of the femoral and popliteal veins for deep venous thrombosis. • “pipes” portion of the protocol is usually not performed in the setting of acute trauma.
  15. 15. • Of these protocols, the • eFAST examination, – pneumothorax, and – subcostal view of the heart • RUSH examination, – evaluation of the IVC,
  16. 16. Heart • Subxiphoid images of the heart • transducer on the upper abdomen aiming superiorly toward the left shoulder. • Fluid surrounding the heart  anechoic space surrounding the myocardium
  17. 17. Hemothorax or Pleural Effusion • The right pleural space  interface between the dome of the liver and diaphragm • echogenic curvilinear line, and echoes similar to liver parenchyma • Normal lung may intermittently distort this interface during inspiration, referred to as the “curtain sign” • anechoic or have mixed (hemorrhage, exudate, transudate, empyema). • Atelectatic lung can also be seen with this view • Upright or reverse Trendelenburg positioning
  18. 18. Pneumothorax • high-frequency (5 MHz) preferred, but • lower frequency sector transducers / curved transducer • placed in the second or third intercostal space in the midclavicular line in sagittal orientation moved inferiorly • oblique fashion • most helpful - “sliding lung” sign. • The echogenic line representing the normal visceral/ parietal pleural interface • Absence of the normal sliding lung
  19. 19. A-lines • normal lung. • reverberation artifacts from the visceral and parietal pleura. • always equally spaced.
  20. 20. B Lines • vertical lines running from the transducer that may extend to the edge of the screen • normal lung there is • A-lines are perfectly spaced, and the B-lines are very small. • “lung rockets.” consolidation or pulmonary edema
  21. 21. With pneumothorax • (a) there is absent sliding lung; • (b) A lines may be present, more numerous than normal, and not evenly spaced; • (c) B-lines are no longer present • Visualization of B-lines with absent sliding lung is not diagnostic of a pneumothorax, as – B-lines usually are never present with a pneumothorax; – if present  lung is not moving but may be diseased.
  22. 22. • junction between normal and abnormal lung can be seen and is called a “lung point” . • Can estimate size of the pneumothorax • M-mode equivalent of lung sliding  “seashore sign,” and when absent, the “barcode sign” is seen corresponding to pneumothorax • “stratosphere sign.”
  23. 23. Inferior Vena Cava • supine position, low-frequency curvilinear transducer. • A subxiphoid approach & sagittal orientation • diameter is measured 2 cm below the cavoatrial junction. • Inspiratory and expiratory diameters are obtained for comparison • Interpretation - diameter and degree of inspiratory collapse of the IVC (nonintubated)
  24. 24. • caval index : [(IVC expiratory diameter - IVC inspiratory diameter)/ IVC expiratory diameter] x 100 . • approaching 100%  complete collapse and likely volume depletion • close to 0%  indicates minimal collapse, suggesting volume overload • For trauma, simplest approach: – if substantial collapse with small diameter (1.5 cm), indicating volume depletion.
  25. 25. limitations • estimation of shock in intubated patients with positive-pressure ventilation – Severe chronic obstructive pulmonary disease, – pulmonary hypertension, – Right-sided heart failure, – cardiac tamponade, and – tricuspid regurgitation. • hypotensive trauma patients with hypovolemic shock owing to its reduced diameter.
  26. 26. Serial FAST • Examination after stabilization • more time for a comprehensive scan • active intraperitoneal hemorrhagefree fluid should increase. • decreased the false-negative rate by 50% • increased sensitivity for free fluid detection from 69% to 85% • logical alternative for stable trauma patients, – sudden change in hemodynamic status or physical examination, and – pregnant patients to mitigate radiation exposure.
  27. 27. Solid Organ Evaluation • well suited to depict abnormalities indicative of injury • diffuse heterogeneous pattern  splenic lacerations • discrete hyperechoic pattern  hepatic lacerations . • Subcapsular splenic hematomas - hyperechoic or hypoechoic rims surrounding the parenchyma and • splenic lacerations - hypoechoic over a few days. • For urological trauma, – high-grade renal injuries - mixed echogenicity with a disorganized pattern, and – bladder hematomas frequently appear echogenic
  28. 28. Bowel and Mesenteric Injury • Early detection is difficult – volume of hemorrhage and/or extravasated bowel contents is usually minimal • Loops of fluid-filled bowel should not be confused with free intraperitoneal fluid. • Bowel loops - round and have peristalsis. • pneumoperitoneum from bowel perforation can mimic air within small and large bowel loops
  29. 29. Pneumoperitoneum • Free air shifts to the least dependent areas of the peritoneal cavity with change in patient position  “shifting phenomenon” • When both free fluid and air are present in the peritoneal cavity, “peritoneal stripe sign” • thickened echogenic peritoneal stripe with or without reverberation artifacts
  30. 30. Pregnant Patients • no contrast material or radiation exposure to the mother or fetus. • rapid assessment for free fluid • assess for fetal heart motion, fetal activity, amniotic fluid volume, approximate gestational age, and placenta. • Similar sensitivity and specificity as non pregnant
  31. 31. • Placenta examination is very important, as abruption may have a variety of appearances, such as thickened or avascular regions in the placenta without accompanying free fluid in the pelvis • Fetal organs and cardiac activity • Free intraperitoneal fluid may result from hemorrhage due to solid organ IAI, amniotic fluid from uterine rupture, or both.
  32. 32. FAST and Pediatric Patients • sensitivities, specificities, and accuracies similar to those in adults • used to decrease radiation exposure from CT. • Children with low or moderate suspicion of IAI were less likely to undergo CT if they had a negative FAST examination
  33. 33. Future Applications • prehospital setting is becoming more commonplace as US equipment becomes more compact and lightweight. • use in the field - ideal for rapid triage of injured patients in multiple casualty • The use of US for detecting long bone and pelvis fractures, especially in mass casualty incidents • Outcome prediction for trauma patients arriving in pulseless traumatic arrest
  34. 34. • weightless situations and on the International Space Station • role of contrast-enhanced US for trauma - appears to be a promising method to improve detection of parenchymal organ IAI
  35. 35. Conclusion • Ideal for conservative injury management, especially in children and pregnant or fertile female patients. • Potential applications of contrast-enhanced US include – serial scanning of known organ injuries, – follow- up imaging in patients with inconclusive CT findings – hypersensitivity to iodinated contrast agents.
  36. 36. Reference • Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologist can learn. Radiology: April 2017: 283; (1); 30 - 48

×