Ultrasound training during ATLS: an early start for surgical interns

Abstract

Objectives: Determine if: (1) surgical interns could learn essential ultrasound principles of the focused assessment for the sonographic examination of the trauma patient (FAST) during Advanced Trauma Life Support (ATLS), and (2) swine are adequate models for learning the FAST.

Design: Lecture, videotape, pre/posttests, and practical examination.

Methodology: Day 1: Survey, pretest, lecture, and videotape. Day 2: Three swine, used in ATLS, had diagnostic peritoneal lavage catheters reinserted to infuse fluid and produce "positive" ultrasound examinations. Two fresh swine were "negatives"; however, all five swine were draped similarly to disguise interventions. Interns were tested individually by surgeon-sonographers to determine whether the ultrasound image was "positive" or "negative." Posttests were completed while surgeons performed postmortem examinations on two swine.

Statistics: Paired Student's t test and Wilcoxon Rank Sum test.

Results: Survey (5 min): 48% had exposure to ultrasound. Relationship of test scores showed no significant difference (p = 0.46 to 0.91) between interns with and without ultrasound experience. Tests (30 min): Mean pre- and posttests scores = 65.6 and 90.8, respectively (p < 0.001). Practical examination (140 min): Mean score = 89.6. Postmortem examinations: Left hepatic lobe partially obscured the spleen.

Conclusions: (1) Surgical interns can learn essential ultrasound principles of the FAST during ATLS (2) Swine are feasible models for learning the FAST.