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Radiology
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Much has been written about the role of FAST in trauma (Focused Assessment with Sonography in Trauma). The test involves an ultrasound of five areas of the abdomen, and should only be performed by a suitably qualified operator. Its sole purpose is to detect free intraperitoneal or pericardial blood. Extended FAST can also be performed, which incorporates thoracic views to assess for pneumothorax or haemothorax. It has a reported sensitivity of 90% and a specificity of 95% for detecting intraperitoneal free fluid.11 FAST has some value when it is performed by a dedicated imaging professional, whose sole task is to guide imaging and perform the test concurrently with the resuscitation, rather than as an adjunct.
Trauma to the Colon, Rectum, Anus and Perineum
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Initial evaluation of abdominal trauma following stabilisation of the injured patient may include multiple modalities, depending on the stability of the patient. An acute abdominal series of radiographs (upright and supine abdominal films as well as a left lateral decubitus film) may detect the presence of free intra-peritoneal air. Focused Assessment with Sonography for Trauma (FAST) exams is a quick, non-invasive bedside technique using portable ultrasound to evaluate the presence of free intra-abdominal and pelvic fluid (see Figure 74.1). The technique is operator-dependent, but, with practice, it has been shown to accurately identify the presence of fluid inn the sub-hepatic space, the sub-splenic space, the pericardium and the pelvis. Although accurate in determining the presence of free intra-peritoneal fluid suggestive of intra-abdominal bleed, the accuracy of FAST exam in diagnosing colonic trauma is 38%.18 This is because colonic injuries typically have large amounts of free air, but only small amounts of free fluid.
Multiple choice questions (MCQs)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
FAST (Focused assessment with sonography for trauma) examination refers to a rapid assessment of the abdomen with ultrasound in the emergency setting to look for free fluid. AXR and MRI have no role to play in trauma. CT is the radiological investigation of choice in thoracic and abdominal trauma. Angiography has a specific role to play in pelvic trauma with ongoing haemorrhage, it may be able to localise and treat an individual bleeding vessel.
Does the clinical experience of a tutor influence how students learn extended focused assessment with sonography for trauma: A randomized controlled trial
Published in Medical Teacher, 2023
Cynthia Szalai, Sharaf-Eldin Shehada, Simona Iancu, Frank Herbstreit, Arjang Ruhparwar, Thorsten Brenner, Ali Haddad
Focused assessment with sonography for trauma (FAST) is a part of the resuscitation protocol of trauma patients, recommended by international panel consensus and incorporated into the advanced trauma life support (ATLS) course. Moreover, extended focused assessment with sonography for trauma (eFAST) is now an essential part of the primary survey of an emergency patient (Scalea et al. 1999; Kim et al. 2012). The purpose of FAST is to identify free fluid in acute trauma patients in three potential body spaces, namely, pericardial, pleural, and peritoneal spaces. FAST has a high sensitivity and specificity for identifying free fluid in trauma patients (Brenchley et al. 2006; Tayal et al. 2006; Hsu et al. 2007). eFAST combines ultrasound examination of the abdomen with that of the lungs and heart, to additionally rule out pneumothorax and pericardial effusion/tamponade, respectively. eFAST is a critical bedside tool for managing multiple trauma patients. It is already an integral part of many curricula and is quickly becoming a fundamental skill for all clinicians (Moore and Copel 2011; Hoppmann et al. 2015; Rempell et al. 2016). However, the discrepancy between an increasing number of medical students and the growing clinical commitments of lecturers is a significant challenge in student teaching that needs to be resolved, especially when a competency-based curriculum is being emphasized (Gruppen et al. 2012). The practice of using peers in the clinical education of medical students is a well-established tradition and commonly practiced but lacks definition in its implementation (Secomb 2008; Buscher et al. 2013).
Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review
Published in Prehospital Emergency Care, 2021
Christopher B. Mercer, Matthew Ball, Rebecca E. Cash, Madison K. Rivard, Kirsten Chrzan, Ashish R. Panchal
Of the 16 studies selected for this review, 12 were prospective and observational in design (14–25). We also located three retrospective studies and one randomized control trial utilizing ultrasound in the prehospital environment for trauma (26–29). There was a large geographic disparity of the included studies and only five of the 16 studies were conducted in the United States. The net results of this analysis were 3,317 patients that underwent PHUS examinations for trauma. None of the included studies involved the same cohort of patients or were from the same parent study. Ten of the 16 studies included HEMS. Of note, the 16 included studies used seven different ultrasound screening protocols. They range from FAST (Focused Assessment with Sonography in Trauma); EFAST (Extended Focused Assessment with Sonography in Trauma) (5); PHASE (Pre-Hospital Application of Sonography in Emergencies); Ultrasound-guided peripheral nerve blocks; symptom guided POCUS; EFAST with an Echocardiogram; and PREP (Polytrauma Rapid Echo-Evaluation Program).
How to identify and prioritize procedures suitable for simulation-based training: Experiences from general needs assessments using a modified Delphi method and a needs assessment formula
Published in Medical Teacher, 2018
Leizl Joy Nayahangan, Dimitrios Stefanidis, David E. Kern, Lars Konge
In the needs assessment in radiology, Focused Assessment with Sonography in Trauma (FAST) ranked low after Round 2 (no. 12 out of 22) since it is a procedure that is not only performed by radiologists but also by other specialties such as emergency medicine physicians or surgeons. However, the order of ranking dramatically changed in round 3 (no. 5 out of 13). The panelists recommended and prioritized the increasing need to train FAST in SBT (Nayahangan et al. 2018). In contrast, a needs assessment to identify technical procedures that are important for the early training of urology residents resulted in a high ranking of complex procedures such as robotic surgery in round 2. After round 3, these procedures were down-prioritized, with robotic surgery ranking no. 18 out of 18. While these procedures are important, they can be learned during the later part of residency training (Nayahangan et al. 2017).