Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians

Brenchley, J

doi:10.1136/emj.2005.026864

Cited by 69 publications

(45 citation statements)

References 15 publications

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“…19 FAST is a rapid study utilized to identify hemorrhage. In FAST ultrasound technology is used by properly trained individuals to detect the presence of haemoperitoneum.…”

Section: Local Hemostatic Agentsmentioning

confidence: 99%

The challenge in management of hemorrhagic shock in trauma

Jacob

Kumar

2014

Medical Journal Armed Forces India

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a b s t r a c tTransfusion and resuscitation practices in trauma have undergone a sea change over the past decade. New understanding of transfusion physiology and experiences in military trauma over the last decade has identified key factors taken as challenges in trauma. The most important challenge remains acute traumatic coagulopathy (ATC) which sets in early after a trauma and spirals the patient into shock and continued bleeding. World wide trauma is the leading cause of mortality. More than 6 million deaths occur due to trauma out of which 20% are due to uncontrollable bleeding. Out of the hospital admissions in trauma 20% develop coagulopathy. Mortality is three to four times higher in a patient with coagulopathy and thus prevention and correction of coagulopathy is the central goal of the management of hemorrhagic shock in trauma. Damage control resuscitation (DCR), a strategy combining the techniques of permissive hypotension, hemostatic resuscitation and damage control surgery has been widely adopted as the preferred method of resuscitation in patients with haemorrhagic shock. The over-riding goals of DCR are to mitigate metabolic acidosis, hypothermia and coagulopathy, This article looks at the importance of acute traumatic coagulopathy, its etiology, diagnosis, effects and resuscitation strategies to prevent it and to see the background behind this shift.ª 2014, Armed Forces Medical Services (AFMS). All rights reserved.

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“…19 FAST is a rapid study utilized to identify hemorrhage. In FAST ultrasound technology is used by properly trained individuals to detect the presence of haemoperitoneum.…”

Section: Local Hemostatic Agentsmentioning

confidence: 99%

The challenge in management of hemorrhagic shock in trauma

Jacob

Kumar

2014

Medical Journal Armed Forces India

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“…Ultrasound constitutes an excellent screening technique allowing for quick qualification of the patients, especially the ones that are circulatory unstable, for prompt surgical operation (5,6,14,16,17,(25)(26)(27)(28)(29). Sensitivity of from the tomography laboratory prolongs the time necessary for making the diagnosis thus influencing in some cases prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…This imaging technique still arouses marked interest that is confirmed by continually increasing number of patients diagnosed this way (6,(14)(15)(16)(17). In 1999 "FAST" protocol (acronym of Focused Assessment with Sonography for Trauma) of sonographic examination was proposed (14) defining the aim 498 P. Budzyński et al ity of injuries were blunt injuries -penetrating injuries constituted less than 10% (tab. 1).…”

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confidence: 99%

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Ultrasound in Diagnosing Torso Injuries

Budzyński¹,

Kuliś²,

Brongel³

et al. 2009

Polish Journal of Surgery

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In patients with torso injuries, especially the ones with suspicion of injuries of intraabdominal organs, prompt making of diagnosis and decision about further management plays crucial role. Nowadays ultrasound is the first imaging technique used in Emergency Room in such cases. the aim of the study. Assessment of the value of ultrasound in diagnostics of patients with torso injuries, especially in qualification for operative or conservative treatment. Material and methods. 808 patients with an average age of 44.92 with torso injuries treated in the Department of Emergency Medicine and Multiple Injuries of 2 nd Chair of General Surgery, Medical College of Jagiellonian University from 2004 to 2008, in whom ultrasound according to FAST protocol was used were included in the study. Results of sonographic examinations were verified during surgical operation (in patients treated surgically), or with the use of computed tomography (in patients treated conservatively), or on the basis of post-mortem examination (in patients who died due to sustained injuries), or on the basis of clinical course of hospitalization. Results. Sensitivity of ultrasound in the study material amounted to 90.43%, while specificity as much as 99.44%. Positive predictive value (so percentage of patients with truly positive result amongst the patients with positive result of diagnostic test) for whole study material was 95.5 while negative predictive value was 98.75. Conclusion. Results of the study confirm that ultrasound constitutes imaging technique of unique value in diagnostics of patients suffering from torso injuries, especially the circulatory unstable ones, allowing for precise qualification for prompt surgery.

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“…It has revolutionised many areas of critical care including vascular access [1], the trauma survey [2] and point of care diagnositic imaging [3]. Transthoracic echocardiography (TTE) is currently the preferred method in assessing cardiac function and haemodynamic status despite its well-known limitations [4].…”

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confidence: 99%

Transesophageal echocardiography: A new era for the critical care physician

White¹

2016

Trauma Emerg Care

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CommentaryMedical ultrasound is a ground breaking frontier of medicine, particularly in regard to point of care investigation and intervention. It has revolutionised many areas of critical care including vascular access [1], the trauma survey [2] and point of care diagnositic imaging [3]. Transthoracic echocardiography (TTE) is currently the preferred method in assessing cardiac function and haemodynamic status despite its well-known limitations [4]. For this reason a number of studies have investigated the feasibility and applications of transesophageal echocardiography (TEE) in the critical care setting [4][5][6].In 2013, Charron et al., performed a study investigating the minimum training requirements of non-cardiologists to perform an advanced point of care TEE [5]. In this study, each participant was an intensive care trainee with little or no experience with echocardiography. These trainees were then trained in advanced TEE and assessed at one, three and six months. This study found that the performance of at least 31 examinations over six months were required to reach competence in advanced TEE.In 2015, Arntfield, et al., expanded on the use of TEE as an additional form of basic point of care ultrasound in the emergency department [6]. This study trained a small group of emergency physicians experienced in TTE to perform a basic four view TEE [6]. During a four hour simulation session these physicians were taught to obtain and interpret the mid oesophageal four chamber, mid-esophageal long axis, transgastric short axis and bicaval view. Six weeks later each physician was asked to obtain and interpret these same views. Eight of twelve participants felt confident in performing this task. Despite the lack of perceived confidence, all twelve were able acceptably obtain and assess mid-esophageal four chamber and mid-esophageal long axis views. Eleven of the twelve were able to demonstrate adequate transgastric short axis and bicaval views. The pathological conditions simulated were identified by 100% of participants.These diagnostic findings in simulated TEEs were then replicated in a further study by Arntfield et al., (2016) [4]. This was a retrospective review of 54 TEE examinations performed by 12 ED physicians. In this study the indications included intra cardiac arrest, post cardiac arrest and undifferentiated hypotension. The TEE studies performed the following four views; mid oesophageal four chamber (96%), midesophageal long axis (78%), transgastric short axis (80%) and bicaval (46%) view. Fifty-three of the 54 studies were determinate making it a reliable tool. Furthermore, 78% of the studies had diagnostic influence and impacted therapeutic decisions in 67% of TEEs.These studies demonstrate a much faster training curve [5,6] and greater clinical utility [4] than expected. Commonly, incorporation of TEE meets a great deal of resistance due to the cost of the TEE probe (estimated at $40,000 USD [4]), interdepartmental politics and lack of established training models [4]. Despite this resistance, the ab...

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Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians

Cited by 69 publications

References 15 publications

The challenge in management of hemorrhagic shock in trauma

The challenge in management of hemorrhagic shock in trauma

Ultrasound in Diagnosing Torso Injuries

Transesophageal echocardiography: A new era for the critical care physician

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