Focused Assessment With Sonography for Trauma

Excerpt

Traumatic injury is the leading cause of death among individuals younger than 45 years old . Eighty percent of traumatic injury is blunt with the majority of deaths secondary to hypovolemic shock . In fact, intraperitoneal bleeds occur in 12% of blunt trauma ; therefore, it is essential to identify trauma quickly. The optimal test should be rapid, accurate, and non-invasive. Historically, providers performed diagnostic peritoneal lavage (DPL) to detect hemoperitoneum. While extremely sensitive (96% to 99%) and specific (98%), DPL is an invasive procedure with a complication rate of 1% ,, . CT remains the gold standard for diagnosing intra-abdominal injuries detecting as little as 100 cc of intraperitoneal fluid. However, time delays and transportation out of the emergency department confound the evaluation of hemodynamically unstable patients.

The implementation of point of care ultrasound has significantly impacted the evaluation and treatment of patients . Ultrasound has considerable advantages, including its bedside availability, ease of use, and reproducibility. Furthermore, it is non-invasive, employs no radiation or contrast agents, and is inexpensive. The use of ultrasound to detect intraperitoneal fluid was first described in Europe during the 1970s. However, widespread adoption in the United States did not occur until the 1990s. The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98% . In the subset of hypotensive trauma patients, the sensitivity of the FAST exam approaches 100%. Experienced providers perform the FAST exam in less than 5 minutes , and its use decreases time to surgical intervention, patient length of stay, and rates of CT and DPL. Presently, more than 96% of level 1 trauma centers incorporate FAST into their trauma algorithms as does Advanced Trauma Life Support (ATLS) .

Recently, many institutions have introduced the Extended FAST (eFAST) protocol into their trauma algorithms. The eFAST examines each hemithorax for the presence of hemothoraces and pneumothoraces.