Focused assessment with sonography in trauma (FAST) for the regional anesthesiologist and pain specialist

2019 ◽  
Vol 44 (5) ◽  
pp. 540-548 ◽  
Author(s):  
William Clark Manson ◽  
Meghan Kirksey ◽  
Jan Boublik ◽  
Christopher L Wu ◽  
Stephen C Haskins
Keyword(s):  
Management Practice ◽  
Point Of Care ◽  
Free Fluid ◽  
Point Of Care Ultrasound ◽  
Short Axis ◽  
Pathological Findings ◽  
Chamber View ◽  
Pain Specialist ◽  
Peritoneal Space ◽  
Fast Exam

This article in our point-of-care ultrasound (PoCUS) series is dedicated to the role the focused assessment with sonography in trauma (FAST) exam plays for the regional anesthesiologist and pain specialists in the perioperative setting. The FAST exam is a well-established and extensively studied PoCUS exam in both surgical and emergency medicine literature with over 20 years demonstrating its benefit in identifying the presence of free fluid in the abdomen following trauma. However, only recently has the FAST exam been shown to be beneficial to the anesthesiologist in the perioperative setting as a means to identify the extravasation of free fluid into the abdomen from the hip joint following hip arthroscopy. In this article, we will describe how to obtain the basic FAST views (subcostal four-chamber view, perihepatic right upper quadrant view, perisplenic left upper quadrant view, and pelvic view in the longitudinal and short axis) as well as cover the relevant sonoanatomy. We will describe pathological findings seen with the FAST exam, primarily free fluid in the peritoneal space as well as in the pericardial sac. As is the case with any PoCUS skill, the application evolves with understanding and utilization by new clinical specialties. Although this article will provide clinical examples of where the FAST exam is beneficial to the regional anesthesiologist and pain specialist, it also serves as an introduction to this powerful PoCUS skill in order to encourage clinical practitioners to expand the application of the FAST exam within the scope of regional anesthesia and pain management practice.

scholarly journals Identification of Hollow Viscus Injury with FAST Examination in Kurdistan, Iraq

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ruj Al-Sindy ◽  
Heleen Alaqrawy ◽  
Mahmood Sh. Hafdullah ◽  
Christine Butts
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Organ Injury ◽  
Free Fluid ◽  
Point Of Care Ultrasound ◽  
Solid Organ ◽  
Hollow Viscus ◽  
Northern Iraq ◽  
Hollow Viscus Injury ◽  
Fast Exam

Point-of-care ultrasound has become indispensable in the evaluation of trauma, particularly in low resource areas, where it may be the only rapidly available imaging modality. The FAST (Focused Assessment with Sonography in Trauma) in particular can be lifesaving, by rapidly detecting signs of intra-abdominal hemorrhage. However, the FAST is primarily designed to identify free fluid associated with solid organ injury and is thought to have less sensitivity and power in identifying evidence of hollow viscus injury. We present a case of an unidentified man that presented to a hospital in the Kurdistan region of northern Iraq, a region of low resources, surrounded by war. The FAST exam proved to be the key to identifying this patient’s injuries.

Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

POCUS Journal ◽  
2017 ◽  
Vol 2 (2) ◽  
pp. 15-17
Author(s):  
Rimi Sambi, MD ◽  
Heather Sawula, MD ◽  
Brent Wolfrom, MD ◽  
Joseph Newbigging, MD
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Point Of Care ◽  
Training Session ◽  
Undergraduate Curriculum ◽  
Knowledge Retention ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Medical Undergraduate ◽  
Fast Exam

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing [1]. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University. Third year medical students (n=18) were recruited to participate in a training session involving a 1-hour online video and 2-hour hands-on session. Knowledge based surveys were completed before and after the training. A survey was completed 4 months after the teaching session evaluating knowledge retention, comfort, and application of skills. Student knowledge of PoCUS and FAST increased and was maintained (pre-training 56%±20%, post-training 82%±10%, p<0.001). Self-evaluation of comfort performing a FAST examination (5-point Likert scale) similarly increased post-training session (pre-training 1.4±0.8, post-training 3.8±0.9, p<0.005), but decreased 4 months later (3±1.2, p<0.005). Students in this study were unanimously interested in ultrasound training and the methods used effectively increased theoretical knowledge and comfort with use. Students did not retain their comfort levels with FAST exam 4 months after the training session, nor did they have the opportunity to utilize the skills learned. Further evidence is required to identify the applicability of these results to undergraduate curriculum development.

Prehospital ultrasound use among Canadian aeromedical service providers – A cross-sectional survey

CJEM ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 338-341
Author(s):  
Anna Sedlakova ◽  
Paul Olszynski ◽  
Philip Davis ◽  
John Froh
Keyword(s):  
British Columbia ◽  
Prince Edward Island ◽  
Service Providers ◽  
Point Of Care ◽  
Yukon Territory ◽  
Free Fluid ◽  
Point Of Care Ultrasound ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Disposition

ABSTRACTObjectivesEvidence suggests that prehospital point of care ultrasound (POCUS) may change patient management. It serves as an aid in triage, physical examination, diagnosis, and patient disposition. The rate of adoption of POCUS among aeromedical services throughout Canada is unknown. The objective of this study was to describe current POCUS use among Canadian aeromedical services providers.MethodsThis is a cross-sectional observational study. A survey was emailed to directors of government-funded aeromedical services bases in Canada. Data were analyzed using descriptive statistics.ResultsThe response rate was 82.3% (14/17 aeromedical services directors), representing 41 of 46 individual bases. POCUS is used by aeromedical services in British Columbia, Alberta, Saskatchewan, and Manitoba. New Brunswick, Nova Scotia, Prince Edward Island, and Yukon reported they are planning to introduce POCUS within the next year. Ontario and Newfoundland reported they are not using POCUS and are not planning to introduce it. British Columbia is the only province currently using POCUS on fixed-wing aircraft. Most commonly reported frequency of POCUS use on missions was <25%. Most useful applications are assessment for pneumothorax, abdominal free fluid, and cardiac standstill. The most common barrier to POCUS use is cost of training and maintenance of competence.ConclusionsPrehospital POCUS is available in Western Canada with one third of the Canadian population having access to aeromedical services using ultrasound. The Maritimes and the Yukon Territory will further extend POCUS use on fixed-wing aircraft. While there are barriers to POCUS use, those bases that have adopted POCUS consider it valuable.

scholarly journals Point-of-care Ultrasound Diagnosis of Pulmonary Embolism with Thrombus in Transit

2019 ◽  
Vol 3 (2) ◽  
pp. 11-12 ◽  
Author(s):  
Nicolas Kahl ◽  
Christopher Gabriel ◽  
Shadi Lahham ◽  
Maxwell Thompson ◽  
Wirachin Hoonpongsimanont
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Point Of Care ◽  
Skilled Nursing Facility ◽  
Point Of Care Ultrasound ◽  
Right Heart ◽  
Skilled Nursing ◽  
Chamber View ◽  
The Right ◽  
In Transit

A 95-year-old female with a history of dementia and atrial fibrillation (not on anticoagulation) presented to the emergency department (ED) by ambulance from her skilled nursing facility due to hypoxia. Point-of-care ultrasound was performed, and showed evidence of a large mobile thrombus in the right ventricle on apical four-chamber view. Further evidence of associated right heart strain was seen on the corresponding parasternal short-axis view. These ultrasound findings in combination with the patient’s clinical presentation are diagnostic of acute pulmonary embolism with right heart strain. Point-of-care transthoracic cardiac ultrasound in the ED is an effective tool to promptly diagnose acute pulmonary embolism with right heart strain and thrombus in transit and guide further treatment.

scholarly journals Point of care ultrasound in disaster triage

2017 ◽  
Vol 86 (1) ◽  
pp. 38-39
Author(s):  
Brandon Chau ◽  
Gayathri Sivakumar
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Accurate Method ◽  
Point Of Care Ultrasound ◽  
Life Threatening ◽  
Intraperitoneal Bleeding ◽  
Ultrasound Technology ◽  
Fast Exam ◽  
Disaster Scenario ◽  
The Military

Ultrasound technology has rapidly progressed over the past decades to emerge as a portable, versatile imaging modality to complement the physical exam. It has been shown to be superior to clinical exam and equivalent to computed-tomography in detecting many life-threatening conditions, and thus is used in a variety of resuscitative settings, including the front lines of the military. A variety of imaging protocols exist for ultrasound, but in resource-deplete settings such as a disaster scenario, the focused assessment with sonography for trauma (FAST) exam is a rapid and accurate method of determining acute intraperitoneal bleeding. With improving portability, as well as the ability to transmit images to a centralized command hub, it can become a key component of the first responder’s toolkit.

scholarly journals Are seminal vesicles a potential pitfall during pelvic exploration using point-of-care ultrasound (POCUS)?

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Antoine Fasseaux ◽  
Philippe Pès ◽  
Françoise Steenebruggen ◽  
Florence Dupriez
Keyword(s):  
Online Survey ◽  
Point Of Care ◽  
Seminal Vesicles ◽  
Free Fluid ◽  
Point Of Care Ultrasound ◽  
Ultrasound Images ◽  
Evaluation Tool ◽  
Potential Pitfall ◽  
Therapeutic Benefits ◽  
Dynamic Ultrasound

Abstract Background Trauma is a major cause of death among the working population. Many countries have now adopted a structured approach to trauma management in which ultrasound is used as a primary evaluation tool. While its use has direct therapeutic benefits, many artifacts and pitfalls are inherent to the technique. Knowledge of the most frequently encountered pitfalls in practice could thus help reduce the risk of error and lead to more accurate trauma assessments. Objective This study evaluates a potential pitfall caused by seminal vesicles during focused assessment with sonography for trauma examinations of the male pelvis performed by an emergency physician with experience in point-of-care ultrasound. Methods We took five static and five dynamic (3-s loops) transverse ultrasound images of the pelvis in five healthy males. The images and videos were then incorporated into an online survey and emailed through the World Interactive Network Focused On Critical UltraSound (WINFOCUS) in France and the Ultrasound and Emergency Medicine (UEM) Organization in Belgium. A questionnaire asked anonymous participants to assess the presence of free fluid in the static and dynamic images and to share information about their training and experience in point-of-care ultrasound. To validate the static and dynamic images, the survey was sent to three external radiologists for independent verification. Results A total of 191 individuals responded fully or partially to the survey, 114 of whom completed it. Among the 114 participants who completed the survey, the misinterpretation rate was 0.55 (95CI 0.51–0.60) for all static and dynamic ultrasound transverse pelvic views. The misinterpretation rate was 0.61 (95CI 0.55–0.66) and 0.50 (95CI 0.45–0.55) for static and dynamic ultrasound transverse pelvic views, respectively. The three external radiologists answered the questionnaire correctly without misinterpreting the survey ultrasound views. Conclusions Seminal vesicles are a potential pitfall when interpreting transverse ultrasound images of the male pelvis in the context of point-of-care ultrasound.

Musculoskeletal ultrasound

2019 ◽  
pp. 131-156
Author(s):  
David Lewis
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Assessment ◽  
High Frequency ◽  
Point Of Care ◽  
Musculoskeletal Ultrasound ◽  
Point Of Care Ultrasound ◽  
Short Axis ◽  
Area Of Interest ◽  
High Frequency Transducer ◽  
Normal Ultrasound

Musculoskeletal (MSK) point-of-care ultrasound (PoCUS) increases point-of-care diagnostic accuracy and guides management for localized injuries, infections, and inflammation. It should be considered an adjunct to the MSK clinical assessment. The area of interest is examined in two planes (long- and short-axis), utilizing a high-frequency transducer. A machine-split screen can be used to compare the area of interest with the contralateral normal; however, an understanding of the normal ultrasound appearance of MSK structures and knowledge of relative anatomy is required to become proficient.

Point-of-care ultrasound for the pediatric regional anesthesiologist and pain specialist: a technique review

2020 ◽  
Vol 45 (12) ◽  
pp. 985-992 ◽  
Author(s):  
Michelle S Kars ◽  
Andrea Gomez Morad ◽  
Stephen C Haskins ◽  
Jan Boublik ◽  
Karen Boretsky
Keyword(s):  
Systolic Function ◽  
Point Of Care ◽  
Pediatric Emergency ◽  
Infants And Children ◽  
Pediatric Care ◽  
Point Of Care Ultrasound ◽  
Cardiac Volume ◽  
Pain Specialist ◽  
Airway Devices ◽  
In Infants And Children

Point-of-care ultrasound (PoCUS) has been well described for adult perioperative patients; however, the literature on children remains limited. Regional anesthesiologists have gained interest in expanding their clinical repertoire of PoCUS from regional anesthesia to increasing numbers of applications. This manuscript reviews and highlights emerging PoCUS applications that may improve the quality and safety of pediatric care.In infants and children, lung and airway PoCUS can be used to identify esophageal intubation, size airway devices such as endotracheal tubes, and rule in or out a pulmonary etiology for clinical decompensation. Gastric ultrasound can be used to stratify aspiration risk when nil-per-os compliance and gastric emptying are uncertain. Cardiac PoCUS imaging is useful to triage causes of undifferentiated hypotension or tachycardia and to determine reversible causes of cardiac arrest. Cardiac PoCUS can assess for pericardial effusion, gross ventricular systolic function, cardiac volume and filling, and gross valvular pathology. When PoCUS is used, a more rapid institution of problem-specific therapy with improved patient outcomes is demonstrated in the pediatric emergency medicine and critical care literature.Overall, PoCUS saves time, expedites the differential diagnosis, and helps direct therapy when used in infants and children. PoCUS is low risk and should be readily accessible to pediatric anesthesiologists in the operating room.

scholarly journals An evaluation of the accuracy of prehospital eFAST in the assessment of polytrauma by a physician-staffed helicopter emergency medical service

2020 ◽  
Author(s):  
Christopher Partyka ◽  
Matthew Miller ◽  
Jimmy Bliss ◽  
Brian Burns ◽  
Andrew Coggins ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Emergency Medical Service ◽  
Primary Outcome ◽  
Medical Service ◽  
Point Of Care ◽  
Helicopter Emergency Medical Service ◽  
Prehospital Setting ◽  
Free Fluid ◽  
Point Of Care Ultrasound ◽  
List Type

ABSTRACTBACKGROUNDWhile the accuracy of point of care ultrasound in trauma is well understood, there is limited reporting on the efficacy of prehospital ultrasound by helicopter emergency medical service (HEMS). In severe trauma, early diagnosis and communication of life-threatening injuries has the potential to facilitate timely care. This HEMS ultrasound registry evaluation set out to report the accuracy of the extended focused assessment with sonography in trauma (eFAST) exam.METHODSRetrospective review of trauma patients who received a prehospital eFAST by GSA-HEMS clinicians between 1 January 2013 and 31 December 2017. Clinician interpretations of these scans were compared to immediate in-hospital CT imaging or operating room reports as the gold-standard reference. The primary outcome measure was the accuracy of eFAST for intraperitoneal free fluid compared to hospital CT scan. Secondary outcomes included accuracy of eFAST for pneumothorax, haemothorax and pericardial fluid, comparison of clinician seniority and whether prehospital interventions were supported by eFAST results.RESULTSWe included 896 patients who underwent eFAST by prehospital clinicians. 411 patients had adequate in-hospital data available for comparison. For the primary outcome of IPFF, eFAST had a sensitivity of 25% [95% CI 16-36%] and specificity of 96% [95% CI 93-98%]. Sensitivities and specificities were calculated for pneumothorax (38% and 96% respectively), haemothorax (17% and 97% respectively) and pericardial effusion (17% and 100% respectively). Fifty percent of patients had thoracostomies supported by lung US whilst 24% of patients who received a prehospital blood transfusion had an eFAST negative for haemorrhage.CONCLUSIONThis study shows that prehospital eFAST is a reliable tool for ruling in the diagnoses of intraperitoneal free fluid, pneumothorax, haemothorax and pericardial effusion and as expected less reliable than CT imaging for these injuries.What is already known about this subject?Extended Focused Abdominal Sonography in Trauma (eFAST) is widely used in an in hospital setting for the assessment of blunt and penetrating injury.Point of care sonography in the prehospital setting has become feasible due to advances in technology, widespread physician training and availability of scanning devices.What does this study add?Our study demonstrates that prehospital eFAST is highly specific for the diagnosis of significant abdominal haemorrhage.Prehospital eFAST is less accurate for other injuries including haemothorax and pneumothorax. The explanation for this finding is unclear, but may be associated with scanning earlier in the clinical course, diminishing sensitivity, environmental factors or human factors.Further studies are required to understand the optimal role of point of care ultrasound in the prehospital setting.

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