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In evaluating trauma patients with abdominal trauma, do
you perform an ER bedside ultrasound assessment or evaluate the patient
in the CT or US department? |
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Dr. Neil Specht
responds:
ANSWER: At my institution, we evaluate trauma patients in the Emergency
Department for abdominal fluid collections (i.e., hemoperitoneum) utilizing
a focused, rapid bedside ultrasound exam protocol. Following is the exam
protocol:
Focused Abdominal Sonogram for Trauma (FAST)
1. An ultrasound machine and operator will be available 24 hours per day
for performance of FAST scan on trauma patients in the Emergency Department.
2. The exam will be performed by an ultrasound technologist or attending
radiologist. Immediate notification and appropriate lead time for the Ultrasound
division is essential for prompt assessment of the trauma patient.
3. After normal daytime hours and on weekends, an ultrasound machine will
be placed in the Emergency Department for performance of FAST scans. During
these times, the exam will be performed by the radiology resident on call.
Scanning Protocol for FAST ultrasound scan:
This scan is performed with the patient supine.
An ultrasonic examination of the trauma patient will comprise assessment
of the following areas for the rapid detection of fluid collections and/or
organ injury:
1. Right Upper Quadrant: sagittal scan of RUQ for assessment of the subhepatic
space (the most common location to detect hemoperitoneum).
2. Left Upper Quadrant: sagittal scan of LUQ for assessment of the splenorenal
region.
3. Pericardium: a subxyphoid approach using the liver as a window or parasternal
window to be used.
4. Pelvis: sagittal and/or transverse scan for assessment for fluid in the
Pouch of Douglas.
5. Right Thorax: coronal scan along right mid axillary line to include the
liver, diaphragm and lower right pleural space.
6. Left Thorax: coronal scan along left mid to posterior axillary line to
include the spleen, diaphragm and left pleural space.
All 6 areas of evaluation are to be documented on film and a preliminary
report is to be given immediately at the conclusion of the study. An official
report will be dictated at the next ultrasound film review.
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