Applicability of a modified EFAST protocol (r-EFAST) to evaluate hemodynamically unstable patients after percutaneous cardiac intervention

Abstract

Percutaneous cardiac intervention is an invasive diagnostic and therapeutic technique which carries a significant complication rate. Although the usefulness of EFAST protocol is widely recognised, this paper will attempt to explore a modified approach involving a focused examination on the retroperitoneal (r-EFAST). We have provided examples of 3 cases where r-EFAST was used to detect retroperitoneal bleeding in critical situations.

Trends in point-of-care ultrasound protocols in the emergency department and intensive care unit: a review

“…Identification of the cause of nontraumatic hypotension GDE [16] The parasternal long and short axis, apical 4-chamber plane, subcostal inferior vena cava, and other planes Left and right ventricle pump function, pericardial effusion, septal dynamics, valvular disease, and fluid responsiveness RUSH [17] Parasternal long and short axis, subxiphoid 4-chamber plane and apical 4-chamber plane, the diameter of the inferior vena cava/internal jugular vein, respiratory variation index, and the aorta and deep venous system Rapid evaluation of shock patients and determination of the cause THIRD [19] Pericardial effusion, 5 groups of indicators related to the heart, 3 groups of indicators related to the inferior vena cava and lung, deep vein thrombosis, or aortic dissection Identification of obstructive shock (pericardial tamponade, tension pneumothorax, pulmonary embolism, and pulmonary hypertension), hypovolemic shock (hemorrhagic shock, aortic aneurysm, and aortic dissection), cardiogenic shock (acute myocardial infarction and heart failure), and distributive shock (including septic shock only) Etiology assessment of cardiac arrest FEEL [20] and FEER [22] Subxiphoid 4-chamber plane, parasternal long and short axis, apical 4-chamber plane Identification of the reversible cause of cardiac arrest, accurate identification of ventricular fibrillation, and identification of PEA Assessment of Acute trauma FAST, [24] EFAST, [18] r-EFAST, [26] and FASTER [27] Perihepatic, pelvic, and pericardial Determination of occult abdominal hemorrhage, pericardial effusion, and pneumothorax BEAT [28] The parasternal long-axis plane, the parasternal short-axis plane and apical 4-chamber plane Used for bedside cardiac function assessment of trauma or critical patients Combined with advanced technologies, such as artificial intelligence, it will play an increasingly important role in saving patients with critical illnesses.…”

“…Extended focused assessment with sonography for trauma [18,24] is based on FAST and includes the assessment of pneumothorax; its ability to distinguish pneumothorax in the supine position is better than X-ray. In addition, the modified extended focused assessment with sonography for trauma [26] was proposed to detect retroperitoneal bleeding after cardiac intervention and other operations. Focused abdominal sonography trauma extremity respiratory protocol [27] is mainly used for patients with extremity injuries and is necessary to increase the scanning of the long bones, limbs, and respiratory system.…”

Retroperitoneal Hematoma Following Elective Abdominal Aortic Aneurysm Repair: A Case Report

“…4 Distinguishing the peritoneal from retroperitoneal space can be challenging on ultrasound, but assessing the pararenal space can identify retroperitoneal hematoma. 4,5 If there is a high index of suspicion for retroperitoneal hematoma despite a negative POCUS scan, CT imaging is required. 4 Specific risk factors for retroperitoneal hematoma development in our patient may have been severe aneurysmal angulation and proximity to the IVC requiring close dissection.…”

Urgent ultrasonographic diagnostics in acute traumatic abdominal conditions: Urgent ultrasound in abdominal trauma

“…Sama ekstravazacija krvi ne može da se detektuje ultrazvučno 3 . Retroperitonealno krvavljenje je jedna od najozbiljnijih komplikacija akutne abdominalne traume, iz razloga što retroperitonealni prostor može da primi veću količinu krvi bez kliničkih simptoma i znakova, dok se hipovolemija javlja u kasnijem kliničkom toku 4 . Ultrazvučna evaluacija retroperitoneuma podrazumeva postavljanje sonde u dodatne skenove, od kojih su neki i u lateralnom dekubitusu, iz razloga oskudnog akustičnog prozora za neke od retroperitonealnih kompartmenta.…”