abdominal trauma and fast scan (dr. derhim afaqeeh , yemen )
DESCRIPTION
Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )TRANSCRIPT
![Page 1: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/1.jpg)
الرحمن الله بسم الرحيم
الرحمن الله بسم الرحيم
![Page 2: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/2.jpg)
ABDOMINAL TRAUMA AND FAST SCAN
.
Dr. Derhim Alfaqeeh Radiologist Consultant
HO The Radiology Dept University Of Science And Technology Hospital -
Sana’a Decimber 17, 2013
ABDOMINAL TRAUMA AND FAST SCAN
.
Dr. Derhim Alfaqeeh Radiologist Consultant
HO The Radiology Dept University Of Science And Technology Hospital -
Sana’a Decimber 17, 2013
![Page 3: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/3.jpg)
What does it Mean?What does it Mean?
FASTFocused Abdominal (Assessment with)Sonography in Trauma
![Page 4: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/4.jpg)
INTRODUCTION INTRODUCTION
1980s- US for trauma in Japan, Germany 1990s- US for trauma in North America The term FAST introduced in 1996
1980s- US for trauma in Japan, Germany 1990s- US for trauma in North America The term FAST introduced in 1996
![Page 5: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/5.jpg)
Goals of this lectureGoals of this lecture Where do I put the probe? How do I hold the probe? What am I looking at? - Normal anatomy What am I looking at? - Abnormal anatomy What can I tell from the abnormal anatomy?
Pathologic fluid in the abdomen Pathologic fluid in the pericardium , pleura Visceral injuries
Does it make a difference in management?
![Page 6: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/6.jpg)
PhysicsPhysics Ultrasound is a mechanical longitudinal wave
with a frequency exceeding the upper limit of human hearing (20 KHZ )
Medical ultrasound usually 2MHZ to 16 MHZ Ultrasound transducers send out ultrasound
waves and then “listen” for returning echoes Most transducers at this time send out waves
only approximately 1% of the time Hperechoic (greatest intensity, white) stone, gas Anechoic (no echoes , black ) fluid Hypoechoic (intermediate, shades of gray)
tissues, lesions
Ultrasound is a mechanical longitudinal wave with a frequency exceeding the upper limit of human hearing (20 KHZ )
Medical ultrasound usually 2MHZ to 16 MHZ Ultrasound transducers send out ultrasound
waves and then “listen” for returning echoes Most transducers at this time send out waves
only approximately 1% of the time Hperechoic (greatest intensity, white) stone, gas Anechoic (no echoes , black ) fluid Hypoechoic (intermediate, shades of gray)
tissues, lesions
transducer
![Page 7: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/7.jpg)
![Page 8: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/8.jpg)
TechniqueTechnique Low frequency probe 2.5 – 5.0
MHz Tissue penetration For deep structures High frequency probe 5 - 10
MHz Tissue penetration For superficial structures
Remember: Probe marker almost ALWAYS facing either patient’s right or patient’s head
![Page 9: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/9.jpg)
FAST: ApplicationsFAST: Applications Indications
Acute blunt or penetrating torso trauma (stable or unstable patient )
Trauma in pregnancy Pediatric trauma Subacute torso trauma(unexplained hypotension)
Goal: To identify fluid in a location where it does not normally belong and detect visceral injury.
Indications Acute blunt or penetrating torso trauma (stable or
unstable patient ) Trauma in pregnancy Pediatric trauma Subacute torso trauma(unexplained hypotension)
Goal: To identify fluid in a location where it does not normally belong and detect visceral injury.
![Page 10: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/10.jpg)
Where can I see FF?Where can I see FF?
Free fluid usually appears anechoic by US (black ) Accumulation in area of injury Overflows into dependent areas (pouch of Douglas,
Morrison’s pouch) via rivers (paracolic gutters)
Free fluid usually appears anechoic by US (black ) Accumulation in area of injury Overflows into dependent areas (pouch of Douglas,
Morrison’s pouch) via rivers (paracolic gutters)
![Page 11: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/11.jpg)
FAST: AnatomyFAST: Anatomy
7 Dependent Sites
1. Right Supramesocolic (Morison’s pouch)
2. Left Supramesocolic (Splenorenal rescess)
3. Right Pericolic gutter
4. Right Inframesocolic
5. Left Inframesocolic
6. Left Pericolic gutter
7. Pelvic cul-de-sac
7 Dependent Sites
1. Right Supramesocolic (Morison’s pouch)
2. Left Supramesocolic (Splenorenal rescess)
3. Right Pericolic gutter
4. Right Inframesocolic
5. Left Inframesocolic
6. Left Pericolic gutter
7. Pelvic cul-de-sac
![Page 12: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/12.jpg)
FAST: Technical ConsiderationsFAST: Technical Considerations• Standerded views (standerded
FAST ): 1 -Subxiphoid/Subcostal:
Pericardium 2 -RUQ: Morrison’s Pouch
3-Pelvis: Pelvic Cul-de-sac (Douglas )
Transverse Longitudinal
4- LUQ: Splenorenal & perisplenic spaces
• Extended views (E-FAST) :For pleural effusion
Remember: Probe marker almost ALWAYS facing either patient’s right or patient’s head
Supine patient
1
42
3
![Page 13: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/13.jpg)
![Page 14: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/14.jpg)
1) Subxiphoid exam1) Subxiphoid exam Probe placed
Transversally Midline plane Just below subxiphoid
region
Probe facing towards patient’s right
![Page 15: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/15.jpg)
FAST: Subxiphoid examFAST: Subxiphoid exam Normal Anatomy Liver at very top of screen Epicardial fat vs. effusion
Thin layer anterior to RV
Not present posterior to LV
Normal Anatomy Liver at very top of screen Epicardial fat vs. effusion
Thin layer anterior to RV
Not present posterior to LV
Anterior
Posterior
Left Right
![Page 16: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/16.jpg)
Normal Subxiphoid examNormal Subxiphoid exam
![Page 17: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/17.jpg)
FAST: Subxiphoid examFAST: Subxiphoid exam
Pericardial Effusion
![Page 18: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/18.jpg)
Pericardial EffusionPericardial Effusion
![Page 19: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/19.jpg)
Types of pericardial effusions, subxiphoid cardiac view.Left image: typical effusion, middle image: clotted effusion , right image : with cardiac tamponade .
![Page 20: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/20.jpg)
2)FAST: RUQ exam2)FAST: RUQ exam Probe placed
Perpendicular Mid-coronal plane Just superior to the iliac
crest Probe facing
Toward patient’s head
Probe placed Perpendicular Mid-coronal plane Just superior to the iliac
crest Probe facing
Toward patient’s head Evaluating
Hepatorenal interface Possibility of fluid in
Morison’s pouch ( Right Supramesocolic space)
Evaluating Hepatorenal interface Possibility of fluid in
Morison’s pouch ( Right Supramesocolic space)
![Page 21: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/21.jpg)
FAST: RUQ examFAST: RUQ exam Normal Anatomy In the supine
patient, the hepatorenal space (Morison’s Pouch) is the most dependent space
Normal Anatomy In the supine
patient, the hepatorenal space (Morison’s Pouch) is the most dependent space
Anterior
Posterior
Inferior Superior
Morison’sPouch
![Page 22: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/22.jpg)
FAST: RUQ examFAST: RUQ exam
![Page 23: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/23.jpg)
FAST: RUQ examFAST: RUQ exam
L
K
FF
RS
D
![Page 24: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/24.jpg)
FAST: RUQ examFAST: RUQ exam
L
K
FF
![Page 25: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/25.jpg)
3)FAST: Pelvis exam3)FAST: Pelvis exam Pelvis: Longitudinally and Transvers Axis. Probe placed
Transeversally than Longitudinally Midline 2 cm superior to the symphysis pubis “aimed” caudally into the pelvis (prostate )
Probe facing Toward patient’s head and right side.
Best with some urine in bladder(acoustic window) Evaluating
Bladder ,Uterus in female ,and Prostate in male
The potential spaces are Pouch of Douglas (Cul de sac ) in female and retrovesicle space in male
‘
Pelvis: Longitudinally and Transvers Axis. Probe placed
Transeversally than Longitudinally Midline 2 cm superior to the symphysis pubis “aimed” caudally into the pelvis (prostate )
Probe facing Toward patient’s head and right side.
Best with some urine in bladder(acoustic window) Evaluating
Bladder ,Uterus in female ,and Prostate in male
The potential spaces are Pouch of Douglas (Cul de sac ) in female and retrovesicle space in male
‘
![Page 26: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/26.jpg)
FAST: Pelvis examFAST: Pelvis exam
Pelvis: Longitudinal Axis Normal Anatomy In the erect patient, the pouch of Douglas
(retrovesicle space ) is the most dependent space
Pelvis: Longitudinal Axis Normal Anatomy In the erect patient, the pouch of Douglas
(retrovesicle space ) is the most dependent space
Longitudinal
Superior
Posterior
Inferior
Anterior
![Page 27: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/27.jpg)
retrovesicle space
Pouch of Douglas (Cul de sac )
![Page 28: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/28.jpg)
Mild fluid in pouch of Douglas
Longitudinal
![Page 29: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/29.jpg)
![Page 30: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/30.jpg)
FAST: Pelvis examFAST: Pelvis exam
Pelvis: Transverse Axis Normal Anatomy
Evaluating Bladder Well
cirucumscribed Contains fluid that
appears anechoic
Pelvis: Transverse Axis Normal Anatomy
Evaluating Bladder Well
cirucumscribed Contains fluid that
appears anechoic
Transverse
Anterior
Right Left
Posterior
![Page 31: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/31.jpg)
Transverse
Pouch of Douglas Retrovesicle space
![Page 32: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/32.jpg)
Transverse
![Page 33: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/33.jpg)
FAST: Pelvis exam - Pathology
FAST: Pelvis exam - Pathology
Transverse
![Page 34: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/34.jpg)
Bladder
FF
Transverse
![Page 35: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/35.jpg)
4)FAST: LUQ exam4)FAST: LUQ exam Probe placed
Perpendicular Mid - coronal plane Just superior to the iliac crest
Probe facing Towards patient’s head
Evaluating Spleno-renal interface Possibility of fluid in
splenorenal recess and presplenic /subphrenic space( most common space for fluid collection in LUQ)
Probe placed Perpendicular Mid - coronal plane Just superior to the iliac crest
Probe facing Towards patient’s head
Evaluating Spleno-renal interface Possibility of fluid in
splenorenal recess and presplenic /subphrenic space( most common space for fluid collection in LUQ)
![Page 36: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/36.jpg)
FAST: LUQ examFAST: LUQ exam Normal Anatomy More difficult to evaluate than
RUQ (do not have liver as acoustic window)
Left kidney more superior than right
Splenorenal Recess , Potential space between kidney and spleen
Presplenic /subphrenic space between spleen and diaphragm ( most common space for fluid collection in LUQ)
Normal Anatomy More difficult to evaluate than
RUQ (do not have liver as acoustic window)
Left kidney more superior than right
Splenorenal Recess , Potential space between kidney and spleen
Presplenic /subphrenic space between spleen and diaphragm ( most common space for fluid collection in LUQ)
Anterior
Inferior Superior
Posterior
Splenorenal Recess
Presplenic space
![Page 37: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/37.jpg)
FAST: LUQ examFAST: LUQ exam
![Page 38: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/38.jpg)
![Page 39: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/39.jpg)
FF
![Page 40: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/40.jpg)
Kidney
Spleen
FF
Diaphragm
![Page 41: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/41.jpg)
Don’t mistake Don’t mistake
![Page 42: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/42.jpg)
Don’t mistake
![Page 43: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/43.jpg)
Don’t mistake Don’t mistake
![Page 44: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/44.jpg)
![Page 45: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/45.jpg)
FAST DemoFAST Demo
![Page 46: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/46.jpg)
FAST Focused Abdominal Sonography In Trauma
FAST Focused Abdominal Sonography In Trauma
Reliability accuracy 86 - 97 % sensitivity 88 - 91.7 % specificity 94.7 - 99 %
Can detect 70 ml fluid (by linear probe can detect as little as 10 ml or less)
Reliability accuracy 86 - 97 % sensitivity 88 - 91.7 % specificity 94.7 - 99 %
Can detect 70 ml fluid (by linear probe can detect as little as 10 ml or less)
![Page 47: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/47.jpg)
How To Interpret FASTHow To Interpret FAST
Positive: Fluid in pericardium or any 1 of 4 abdominal windows
Negative: No fluid in any windows
Indeterminate: If any one of the 4 windows is inadequately visualized
Positive: Fluid in pericardium or any 1 of 4 abdominal windows
Negative: No fluid in any windows
Indeterminate: If any one of the 4 windows is inadequately visualized
![Page 48: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/48.jpg)
Does FAST Make a Difference In Trauma Management?Does FAST Make a Difference In Trauma Management?
During primary or secondary survey During primary or secondary survey
FAST
Positive Negative
Indeterminate
unstable stable
OR CT
unstable stable
ORDPL
CTDPL
Serial exam Repeat US/ CT
Adapted from: Rozycki GS, et al. J Trauma, 1996
![Page 49: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/49.jpg)
Pearls Pearls
Lack of FF ≠ no injury Not enough to see (?too early) You missed it Hard-to-see places
FF may not be blood Urine, lavage fluid, ascites,
amniotic fluid, bowel contents, ruptured cyst
Lack of FF ≠ no injury Not enough to see (?too early) You missed it Hard-to-see places
FF may not be blood Urine, lavage fluid, ascites,
amniotic fluid, bowel contents, ruptured cyst
![Page 50: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/50.jpg)
Advantages
Easy & Early to Diagnose in Resuscitation/Emergency room
Rapid(1 – 2.5 min) Repeatable Non-invasi Low cost.
![Page 51: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/51.jpg)
Difficult to distinguish Type of fluid Site of bleeding , Solid organ injury
Cannot evaluate retroperitoneum Difficult in the obese patient , subcutaneous emphysema Examiner Dependent. Bowel gas interposition False –Negative : retroperitoneal & Hollow viscus injury
Disadvantages
![Page 52: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/52.jpg)
Pitfalls and limits
• -Pre-exsiting fluid collection ( Ascites , dialysis )• -Pelvic fluid collection (female ) .• -Fluid filled bowel loops .• -Contained injury (hollow viscus, bowel wall
contusion, pancreatic trauma and renal pedicle injury)• -Echogenic clot.
The scan should be repeated during the secondary survey and also if the patient demonstrates clinical deterioration, since free fluid may have accumulated in the intervening time .The quality of images obtained may also be a limiting factor with patient obesity , gas in the bowel leading to degradation in image quality , subcutaneous emphysema , non-mobile patient and pnetrating injury.
![Page 53: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/53.jpg)
Does FAST replace CT?Does FAST replace CT? Unstable patient, (+) FAST OR Stable patient, low force injury, (-) FAST consider observing patient.
CT is far more sensitive than FAST for detecting and characterizing abdominal injury in trauma. The gold standard for characterizing intraparenchymal injury.
“Death begins with a CT.” Never send an unstable patient to CT. FAST, however, can be performed during resuscitation.
Unstable patient, (+) FAST OR Stable patient, low force injury, (-) FAST consider observing patient.
CT is far more sensitive than FAST for detecting and characterizing abdominal injury in trauma. The gold standard for characterizing intraparenchymal injury.
“Death begins with a CT.” Never send an unstable patient to CT. FAST, however, can be performed during resuscitation.
FAST
Positive NegativeIndeterminate
unstable stable
OR CT
unstable stable
OR
DPL
CT
DPL
Serial exam Repeat US/ CT
![Page 54: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/54.jpg)
![Page 55: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/55.jpg)
??Is Pneumoperitoneum Can Be Detected By US?
YES
Is Pneumoperitoneum Can Be Detected By US?
YES
![Page 56: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/56.jpg)
Pneumoperitoneum Pneumoperitoneum
![Page 57: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/57.jpg)
Extended FAST (E-FAST)Extended FAST (E-FAST)RUQ, LUQ views: Check above diaphragm for hemothorax
CXR = US in detection of hemothoraxMa and Mateer. Ann Emerg Med, 1997
50-175cc vs. 20cc or less US does not replace CXR
Suprapubic view: Check uterus for pregnancy
RUQ, LUQ views: Check above diaphragm for hemothorax
CXR = US in detection of hemothoraxMa and Mateer. Ann Emerg Med, 1997
50-175cc vs. 20cc or less US does not replace CXR
Suprapubic view: Check uterus for pregnancy
![Page 58: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/58.jpg)
HemothoraxHemothorax
KD
SPFF
D
![Page 59: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/59.jpg)
Pleural Fluid
![Page 60: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/60.jpg)
Right pleural effusion, transverse subxiphoid view
![Page 61: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/61.jpg)
Don’t mistake Don’t mistake
![Page 62: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/62.jpg)
Lung Scanning for PneumothoraxLung Scanning for Pneumothorax
Comet tails sign and sliding lung
![Page 63: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/63.jpg)
![Page 64: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/64.jpg)
Loss of comet tail and lung sliding movement
Loss of comet tail and lung sliding movement
![Page 65: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/65.jpg)
![Page 66: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/66.jpg)
Hollow Organs
StomachGall bladder
IntestinesUreters, Bladder
Solid Organs
LiverSpleenKidney
Pancreas
Vascular Injury
AortaVena Cava
Major Branches
Abdominal Organ Injury
![Page 67: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/67.jpg)
Blunt InjuryAbdominal TraumaBlunt InjuryAbdominal Trauma
Spleen 25% Liver 15% Hollow viscus 15%
Ileum Sigmoid
Kidney 12% Retroperitoneal 13% Mesentery 5%
Spleen 25% Liver 15% Hollow viscus 15%
Ileum Sigmoid
Kidney 12% Retroperitoneal 13% Mesentery 5%
Compression / deceleration Crushing Shearing Avulsion
Compression / deceleration Crushing Shearing Avulsion
![Page 68: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/68.jpg)
Solid-Organ Injuries (sonographic patterns)
I. Contusion : patchy ill defined non-linear echogenic area .
II. Subcapsular hematoma : under capsule.
III. Intra-parenchymal hematoma : well defined rounded hyperechoic area .
IV. Laceration : linear well defined hper / hypoechoic area.
V. Multiple lacerations/vascular injury (organic fracture ,disorganization )
![Page 69: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/69.jpg)
![Page 70: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/70.jpg)
Liver laceration and hematoma Liver laceration and hematoma
![Page 71: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/71.jpg)
Subcapsular Liver hematoma
![Page 72: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/72.jpg)
Liver laceration and hematoma
![Page 73: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/73.jpg)
Splenic laceration
![Page 74: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/74.jpg)
Spleen hematoma Subcapsular spleen hematoma
![Page 75: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/75.jpg)
Splenic laceration
![Page 76: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/76.jpg)
Preinephric and renal hematoma
Renal laceration
![Page 77: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/77.jpg)
Subcapsular renal hematoma
![Page 78: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/78.jpg)
ReferencesReferences
Vicki E Nobil , Manual of emergency and critical care ultrasound , Cabridge university 2007
Rosen, C. Ultrasound in Emergency Medicine. Emergency Medicine Clinics of North America. August 2004. Volume 22. Number 3.
O. John Ma and James R. Mateer. Emergency Ultrasound. McGraw-Hill. Medical Publishing Division. 2003.
Simon, B. Ultrasound in Emergency and Ambulatory Medicine. Mosby. 1997
Temkin, BB. Ultrasound Scanning: Principles and Protocols. WB Saunders. 1993.
Vicki E Nobil , Manual of emergency and critical care ultrasound , Cabridge university 2007
Rosen, C. Ultrasound in Emergency Medicine. Emergency Medicine Clinics of North America. August 2004. Volume 22. Number 3.
O. John Ma and James R. Mateer. Emergency Ultrasound. McGraw-Hill. Medical Publishing Division. 2003.
Simon, B. Ultrasound in Emergency and Ambulatory Medicine. Mosby. 1997
Temkin, BB. Ultrasound Scanning: Principles and Protocols. WB Saunders. 1993.
![Page 79: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/79.jpg)
![Page 80: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/80.jpg)
Questions?Questions?
![Page 81: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/81.jpg)
![Page 82: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/82.jpg)
![Page 83: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/83.jpg)
![Page 84: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/84.jpg)
![Page 85: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/85.jpg)
![Page 86: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/86.jpg)
![Page 87: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/87.jpg)
![Page 88: Abdominal Trauma and FAST scan (Dr. Derhim Afaqeeh , Yemen )](https://reader033.vdocuments.us/reader033/viewer/2022051513/546cdd11b4af9f7a2c8b51fb/html5/thumbnails/88.jpg)