New Perspectives for Modern Trauma Management – Lessons Learned from 25 Years FAST and 15 Years E-FAST

AbstractE-FAST (Extended-Focused Assessment with Sonography for Trauma) is now a widely utilized and internationally recognized standard exam in trauma care. It is highly accepted by emergency physicians and trauma surgeons alike. Thanks to the popularity of PoCUS (point-of-care ultrasound), it has continued to evolve over the last years and can now improve trauma diagnosis at all stages of the primary ABCDE. This review article summarizes key observations made over recent years and also highlights the extension of FAST into E-FAST in the context of PoCUS and CT developments for modern trauma management. Time has come to learn the lessons from 25 years of FAST and 15 years of E-FAST. We should redefine and position ultrasound in the primary ATLS survey (Advanced Trauma Life Support) on two levels: 1. Basic ATLS with new clinical questions, six additional abdominal image sections and one or more follow-up examinations depending on the clinical situation, and 2. Advanced ATLS with ultrasound applications for the entire trauma ABCDE.

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Knowledge and Proficiency in Skills of Initial Trauma Management among Healthcare Personnel in Secondary Care

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp3i1.2020142 ◽

2020 ◽

Vol 3 (1) ◽

pp. 267-271

Author(s):

HY Embu ◽

SI Nuhu ◽

SP Bishmang

Keyword(s):

Airway Management ◽

Respiratory Distress ◽

Trauma Care ◽

Secondary Care ◽

Life Support ◽

Healthcare Personnel ◽

Advanced Trauma Life Support ◽

Trauma Management ◽

Management Skills ◽

North Central

Advanced Trauma Life Support (ATLS) protocols aim to provide good trauma care by enhancing the skills of medical personnel all over the world and while this is well established in developed countries it does not appear to be so in developing countries. This study aims to assess the knowledge and proficiency in initial trauma management skills among health caregivers in some general/cottage hospitals in north central Nigeria. Questionnaires were developed to assess the knowledge and skills of care givers in airway management, respiratory distress and shock. The questionnaires were administered on caregivers involved in trauma care in some general/cottage hospitals that offer secondary care in a state in north-central Nigeria. There were 34 health workers who responded, 10 (29.41%) were doctors and 24(70.54%) were nurses. Their years of experience were from 2 to 35 years (median 14years). Ten (29.41%) had at least one training in ATLS in the past while 24(70.59%) had none. In assessing their management skills, 97.06% reported they were able to assess the airway, 88.24% could do chin lift, 73.53% jaw thrust while 91.18% were able to insert oral airway. Thirty-one (91.18%) were able to recognize respiratory distress, 88.24 were able to administer oxygen using facemask and 64.71% using nasal prong. Thirty (88.24%) could assess a patient for shock, 82.35% could splint fractures for haemorrhage control. Twenty-seven (79.41%) reported knowing parameters to monitor during resuscitation. We concluded that knowledge of airway management was high but proficiency and confidence in performing these skills were low.

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The abdomen

Point of Care Ultrasound for Emergency Medicine and Resuscitation ◽

10.1093/med/9780198777540.003.0004 ◽

2019 ◽

pp. 89-106

Author(s):

Justin Bowra ◽

Osama Loubani ◽

Paul Atkinson

Keyword(s):

Emergency Medicine ◽

Bowel Obstruction ◽

Peritoneal Fluid ◽

Renal Colic ◽

Point Of Care ◽

Clinical Situation ◽

Point Of Care Ultrasound ◽

Quadrant Pain ◽

Diagnosis And Management ◽

Rule Out

Abdominal point-of-care ultrasound (PoCUS) for intra-peritoneal fluid in trauma is one of the earliest, and now most accepted, uses of PoCUS in emergency medicine and resuscitation. It is an essential part of the e-FAST (Extended Focused Assessment in Trauma) examination. Abdominal PoCUS can also guide diagnosis and management of right upper quadrant pain and renal colic. PoCUS can also ‘rule in’ (but not ‘rule out’) bowel obstruction and appendicitis. Regardless of the clinical situation, PoCUS is used to answer specific binary questions, rather than to perform an exhaustive survey of the abdomen.

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High-frequency transducers for point-of-care ultrasound applications: what is the optimal frequency range?

Internal and Emergency Medicine ◽

10.1007/s11739-013-1014-y ◽

2013 ◽

Vol 9 (4) ◽

pp. 463-466 ◽

Cited By ~ 2

Author(s):

Srikar Adhikari

Keyword(s):

High Frequency ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Frequency Range ◽

Optimal Frequency ◽

Ultrasound Applications

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Major trauma

10.1093/med/9780198786870.003.0004 ◽

2017 ◽

Cited By ~ 1

Author(s):

Ashis Banerjee ◽

Clara Oliver

Keyword(s):

Emergency Medicine ◽

Royal College ◽

Life Support ◽

Spinal Injury ◽

Advanced Trauma Life Support ◽

Trauma Management ◽

National Guidelines ◽

Nice Guidance ◽

Short Answer Question ◽

Adults And Children

Trauma management is a major presentation in the Royal College of Emergency Medicine (RCEM) curriculum for both adults and children due its associated morbidity and mortality. Trauma management can appear in any aspect of the Fellowship of the Royal College of Emergency Medicine (FRCEM) examination, including the short-answer question (SAQ) paper. This chapter focuses on adult trauma, in accordance with the advanced trauma life support (ATLS) guidelines. It provides information on the different aspects of trauma including that of the chest/abdomen/pelvis, in keeping with ATLS and national guidelines. In addition, this chapter highlights the criteria for imaging and management, which may appear in the SAQ paper. It also has a detailed section on head and spinal injury and is linked to current NICE guidance. Paediatric trauma is not covered in this chapter, however, as it is reviewed in Chapter 19.

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Clinical Progress Note: Point-of-Care Ultrasound Applications in COVID-19

Journal of Hospital Medicine ◽

10.12788/jhm.3454 ◽

2020 ◽

Vol 15 (6) ◽

pp. 353-355 ◽

Cited By ~ 4

Author(s):

Benji K Mathews ◽

Seth Koenig ◽

Linda Kurian ◽

Benjamin Galen ◽

Gregory Mints ◽

...

Keyword(s):

Septic Shock ◽

Respiratory Failure ◽

Critical Illness ◽

Literature Search ◽

Point Of Care ◽

Severe Illness ◽

Point Of Care Ultrasound ◽

The Novel ◽

Novel Coronavirus ◽

Ultrasound Applications

COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, was declared a pandemic on March 11, 2020. Although most patients (81%) develop mild illness, 14% develop severe illness, and 5% develop critical illness, including acute respiratory failure, septic shock, and multiorgan dysfunction.1 Point-of-care ultrasound (POCUS), or bedside ultrasound performed by a clinician caring for the patient, is being used to support the diagnosis and serially monitor patients with COVID-19. We performed a literature search of electronically discoverable peer-reviewed publications on POCUS use in COVID-19 from December 1, 2019, to April 10, 2020. We review key POCUS applications that are most relevant to frontline providers in the care of COVID-19 patients.

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