Hand-Held Thoracic Sonography for Detecting Post-Traumatic Pneumothoraces: The Extended Focused Assessment With Sonography For Trauma (EFAST)

Kirkpatrick, Andrew W.; Sirois, Marco; Laupland, Kevin B.; Liu, D; Rowan, Kevin; Ball, Chad G.; Hameed, S. Morad; Brown, Robert R.; Simons, Richard K.; Dulchavsky, Scott A.; Hamiilton, D R.; Nicolaou, Savvas

doi:10.1097/01.ta.0000133565.88871.e4

Cited by 592 publications

(384 citation statements)

References 51 publications

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“…These protocols provide for the use of thoracic ultrasound for the exclusion of pneumothorax and hemothorax. In this context, standardized ultrasound images acquired by nurses according to specific protocols can be just as effective and less expensive than ultrasound performed by physicians [16,17].…”

Section: Riassuntomentioning

confidence: 99%

Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery

et al. 2013

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Introduction Fiberoptic bronchoscopy is the standard method for verifying the correct position of a double-lumen endotracheal tube (DLET) prior to one-lung ventilation. However, it must be performed by a specially trained anesthesiologist and is often resource consuming. The aim of this study was to compare this approach with thoracic ultrasound done by a nurse anesthetist in terms of sensitivity, specificity, and cost-effectiveness. Methods We conducted a prospective cross-over casecontrol study involving 51 adult patients consecutively undergoing thoracic surgery with one-lung ventilation. After orotracheal intubation with a DLET, correct exclusion of the lung being operated on exclusion was assessed first by a certified anesthesiologist using standard fiberoptic bronchoscopy and then by a trained nurse anesthetist using thoracic ultrasound. The nurse was blinded as to the findings of the anesthesiologist's examination. Results The two approaches proved to be equally sensitive and specific, but the ultrasound examination was more rapid. This factor, together with the fact that ultrasound was performed by a nurse instead of a physician, and the costs of materials and sterilization, had a significant economic impact amounting to a net saving of €37.20 ± 5.40 per case. Conclusions Although fiberoptic bronchoscopy is still the gold standard for checking the position of a DLET, thoracic ultrasound is a specific, sensitive, cost-effective alternative, which can be used to rapidly verify the proper function of the tube based on the demonstration of correct lung exclusion.Keywords Thoracic ultrasound Á Anesthesia Á Thoracic surgery Riassunto Introduzione La fibrobroncoscopia è attualmente la tecnica di scelta per la verifica di un corretto posizionamento del tubo endotracheale a doppio lume, prima dell'esclusione polmonare necessaria alla ventilazione monopolmonare. Tale tecnica richiede tuttavia un medico anestesista specialista adeguatamente formato ed è dunque spesso costosa. Scopo dello studio è di compararla all'ecografia toracica effettuata da infermieri anestesisti, in termini di sensibilità, specificità e costo-efficacia. Metodi Abbiamo dunque realizzato uno studio casocontrollo, cross-over, in effettuata da un infermiere anestesista specificamente formato.una coorte continua di pazienti adulti sottoposti a chirurgia toracica in ventilazione monopolmonare. Dopo intubazione oro-tracheale con tubo doppio lume, ciascun paziente è stato sottoposto dapprima a controllo fibrobroncoscopico effettuato da un medico anestesista e successivamente ad ecografia toracica effettuata da un infermiere anestesista specificamente formato per determinare una corretta esclusione del polmone operato. L'infermiere non era a conoscenza dei risultati del controllo fibrocroncoscopico. Risultati Le due tecniche sono risultate comparabili in termini di sensibilità e specificità. L'ecografia toracica è risultata una tecnica significativamente più rapida da eseguire rispetto alla fibrobroncoscopia. Il tempo di esecuzione, unitament...

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Section: Riassuntomentioning

confidence: 99%

Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery

et al. 2013

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“…At least four chest injuries are immediately life threatening and must be identified and treated in primary survey (7): hypertensive pneumothorax, massive hemothorax, cardiac tamponade and flail chest. Extended-FAST (eFAST) is an acronym coined in 2004 [22] to include not only a rapid evaluation of the abdomen and pericardium for the presence of free fluid, but also of the chest for a fast exclusion of pneumothorax. For years, US imaging of the lungs was thought to be impossible because the US beams are attenuated by the air contained in the lungs.…”

Section: Chest and Pleura Efastmentioning

confidence: 99%

“…The most common pitfalls in US imaging of pneumothorax are: bilateral pneumothorax, as this means that the US operator cannot compare the pattern of the normal lung to that of the affected lung [22], false positive outcome due to pre-existing bullous emphysema and false negative outcome due to failure to complete the examination. Diffuse subcutaneous emphysema makes it impossible to identify the pleural line, and US imaging, therefore, becomes ineffective.…”

Section: Pneumothoraxmentioning

confidence: 99%

Bedside US imaging in multiple trauma patients. Part 1: US findings and techniques

Sofia

2013

J Ultrasound

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Objectives The aim of this review article is to present the current views and visions of the role of ultrasound (US) in the management of patients with multiple trauma. The article is divided into two parts. Part 1 (US findings and techniques) will mainly deal with the technical aspects of US imaging in trauma patients and is written also for educational purposes. Part 2 (pathophysiology and US imaging in trauma patients) will deal with integration of US in the clinical and pathophysiological management of multiple trauma patients. Methods A non-systematic review of the literature through PubMed search (restricted to the last 10 years) of original articles and review articles. Results 80 publications were selected for Part 1. Of these 80 articles, the author selected 50 according to personal criteria on the basis of their innovative or original contents (48 original articles and 2 literature review articles); 19 articles were furthermore extracted from the references of the selected publications. The information extracted from these 69 publications was organized into sections dealing with different fields of applications of US imaging in multiple trauma patients. Conclusions US imaging in trauma has evolved from the initial use, i.e., early diagnosis of peritoneal effusion (focused abdominal sonography for trauma), to a wider use known as resuscitative ultrasonography, and is today considered as an extension of physical examination to implement a more effective approach to clinical problems and increase the timeliness and safety of interventions. Keywords Trauma Á Ultrasound Á Ultrasound findings Á Ultrasound techniqueRiassunto Obiettivi L'obiettivo di questa ricerca è di presentare la visione e le opinioni correnti sul ruolo dell'ecografia nella gestione del paziente con politrauma. L'articolo è diviso in due parti: nella prima ('Semeiotica ecografica e tecnica di esecuzione dell'esame') verrà data attenzione agli aspetti prevalentemente tecnici dell'ecografia nel trauma, con intento anche didattico; nella seconda (Fisiopatologia e ecografia clinica del trauma) sarà esplorato il tema dell'integrazione dell'ecografia con la clinica e la fisiopatologia nella gestione del politraumatizzato. Metodi Revisione non sistematica della letteratura. Ricerca su PubMed (restrizione agli ultimi 10 anni) di articoli originali e revisioni. Risultati Per la Parte prima sono stati selezionati 80 articoli, tra i quali sono stati scelti con criteri personali quelli ritenuti innovativi o originali nei contenuti (48 articoli originali, 2 revisioni di letteratura). 19 articoli sono stati estratti dalla bibliografia delle pubblicazioni prescelte. I contenuti estratti dai 69 articoli sono stati organizzati in paragrafi intitolati ai singoli ambiti di applicazione dell'ecografia nel politrauma. Conclusioni L'ecografia del trauma è evoluta dalla iniziale applicazione nella diagnosi precoce del versamento peritoneale (Focused Abdominal Sonography for Trauma o FAST) all'accezione più ampia di Resuscitative Ultrasonography (RUS) e v...

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“…15,20 The most common cause of death especially on the first 24 hours is the bleeding; on the other hand, multiple organ failure is the second most common cause of death.…”

Section: Discussionmentioning

confidence: 99%

“…The first preperitoneal packing was described by Hannover and Zurich groups which were done through transabdominal pelvic packing. 14,15 Direct preperitoneal packing was described in Denver, a surgical technique that was performed through suprapubic midline incision and allows direct retroperitoneal approach to the space of Rezius. 16 Single or multiple procedures can be considered on the management of the patient depending on patient stability after each procedure.…”

Section: Introductionmentioning

confidence: 99%

Management of hemodynamically unstable patients with fracture pelvis Mafraq Hospital experience, UAE

2017

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Background: Multidisciplinary team and multiple approaches were introduced to improve the outcome after significant pelvic trauma. In present study, we are evaluating our institutional management modalities for unstable patients with unstable pelvic fractures using angio-embolization, pelvic packing with or without angio-embolization and conservative management with surgical intensive care unit (SICU) admission.Methods: We reviewed 108 patients admitted with pelvic fractures from January 2013 to September 2014, 19 patients (17.5%) were hemodynamically unstable with pelvic fracture. Massive transfusion protocol was activated in all patients. FAST scan was done. Level 1 trauma CT for the responder and transient responder patients.Results: Out of 19 patients, 7 patients (36.8%) were good responders to resuscitation with maintaining of their hemoglobin stable, with no extravasation of dye, admitted to SICU for conservative management. 4 patients (21%) were responders with CT trauma revealed dye leak so they underwent angio-embolization, SICU admission. 8 patients (42.1%) were non-responders underwent preperitoneal packing, one of them had additional angio-embolization.Conclusions: Preperitoneal packing is an excellent choice for non-responder patients, while angio-embolization can be done for responder and transient responder patients with evident dye extravasation. This study needs more evaluation on a wider clinical scale.

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Hand-Held Thoracic Sonography for Detecting Post-Traumatic Pneumothoraces: The Extended Focused Assessment With Sonography For Trauma (EFAST)

Abstract: EFAST has comparable specificity to CXR but is more sensitive for the detection of OPTXs after trauma. Positive EFAST findings should be addressed either clinically or with CT depending on hemodynamic stability. CT should be used if detection of all PTXs is desired.

Cited by 592 publications

References 51 publications

Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery

Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery

Bedside US imaging in multiple trauma patients. Part 1: US findings and techniques

Management of hemodynamically unstable patients with fracture pelvis Mafraq Hospital experience, UAE

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