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.

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.

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 Abdominal blunt trauma in children: experience from a single center

2019 ◽  
Vol 6 (8) ◽  
pp. 2885
Author(s):  
Santosh Kumar Singh ◽  
Deepak Mittal
Keyword(s):  
Blunt Trauma ◽  
Road Traffic ◽  
Bile Leak ◽  
Operative Intervention ◽  
Organ Injury ◽  
Solid Organ ◽  
Hollow Viscus ◽  
Average Hospital ◽  
Hollow Viscus Injury ◽  
Abdominal Blunt Trauma

Background: Abdominal blunt trauma (ABT) remains an important cause of childhood morbidity and sometimes, mortality. Recently the approach for management of ABT has tilted towards conservative one with excellent results. In this study, we present our experience of ABT from a teaching hospital.Methods: All patients below 17 years with ABT between December 2012 and May 2016 were studied retrospectively and methods and results analyzed.Results: A total of 33 patients presented with ABT, mainly due to fall from height or road-traffic accidents. Age ranged from 3 to17 years. Of the 33 patients, 30 patients had solid organ injuries and only 3 patients had isolated hollow viscus injuries. Operative intervention was needed in 6 (18.2%) patients, of whom three needed upfront surgery. They had had hollow viscus injury. Others who developed signs and symptoms of other injuries included duodenal injury, ureteric transection and delayed adhesive intestinal obstruction following bile leak, one each. Average hospital stay of patients with solid organ injury was 5.4±1.6 days while for those with hollow viscus injury requiring operative intervention, this was 12.3±2.4 days. There was no mortality.Conclusions: ABT is a frequent emergency in children in the developing world. Prompt initial management significantly affects the eventual outcome. Imaging studies are the cornerstone of diagnosing the type and extent of injury. Most patients can be managed conservatively. However, constant masterly vigilance is needed to pick up the evolving signs, thereby avoiding possible complications and morbidity.

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.

scholarly journals The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
A. Pourmand ◽  
U. Dimbil ◽  
A. Drake ◽  
H. Shokoohi
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Imaging Modality ◽  
Point Of Care ◽  
High Sensitivity ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Short Term ◽  
Intestinal Peristalsis

Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO.

Point-of-care ultrasound in a multiplace hyperbaric chamber

2021 ◽  
pp. 221-226
Author(s):  
Kirsten Hornbeak ◽  
◽  
Jay Duchnick ◽  
Anthony Medak ◽  
Peter Lindholm ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Electronic Devices ◽  
Point Of Care Ultrasound ◽  
Clinical Settings ◽  
Proof Of Concept ◽  
Safety Standards ◽  
Patient Assessments ◽  
Hyperbaric Environment ◽  
Hbo2 Therapy

Historically, electronic devices have been generally prohibited during hyperbaric oxygen (HBO2) therapy due to risk of fire in a pressurized, oxygen-rich environment. Point-of-care ultrasound (POCUS), however, has emerged as a useful imaging modality in diverse clinical settings. Hyperbaric chambers treating critically ill patients would benefit from the application of POCUS at pressure to make real-time patient assessments. Thus far, POCUS during HBO2 therapy has been limited due to required equipment modifications to meet safety standards. Here we demonstrate proof of concept, safety, and successful performance of an off-the-shelf handheld POCUS system (SonoSite iViz) in a clinical hyperbaric environment without need for modification.

Paediatric ultrasound

2019 ◽  
pp. 217-224
Author(s):  
Jason Fischer ◽  
Lianne McLean
Keyword(s):  
Critical Care ◽  
Abdominal Pain ◽  
Pyloric Stenosis ◽  
Imaging Modality ◽  
Point Of Care ◽  
Adult Patients ◽  
Point Of Care Ultrasound ◽  
Lung Pathology ◽  
Skull Fractures ◽  
Body Habitus

This chapter highlights the increasing use of point-of-care ultrasound (PoCUS) in children. The size and body habitus of infants and children are often ideal for sonographic visualization and make PoCUS an ideal imaging modality for paediatric patients. PoCUS applications that have been traditionally used for adult patients are increasingly being adopted for the care of children. Paediatric-specific applications are also being developed for problems common and unique to paediatrics. Focused abdominal scans for appendicitis, intussusception, and pyloric stenosis are now frequently used in patients presenting with abdominal pain or vomiting. PoCUS can differentiate lung pathology and is helpful in the assessment of suspected skull fractures in non-verbal infants. Ongoing integration of PoCUS into shock, trauma, and triage algorithms support its increasing role in paediatric emergency and critical care.

scholarly journals MP035: Point-of-care-ultrasound to diagnose appendicitis in a Canadian emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S78-S78
Author(s):  
S. Sharif ◽  
S. Skitch ◽  
D. Vlahaki ◽  
A. Healey
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Retrospective Chart Review ◽  
Fellowship Training ◽  
Point Of Care Ultrasound ◽  
Suspected Appendicitis ◽  
Test Characteristics ◽  
Resident Physicians ◽  
Definitive Management ◽  
Surgical Condition

Introduction: Appendicitis is a common surgical condition that frequently requires patients to undergo diagnostic imaging. Abdominal computed tomography is the gold standard imaging technique for the diagnosis of appendicitis, but exposes patients to radiation. Ultrasound offers an alternate radiation-free imaging modality for appendicitis. However, the availability of ultrasound during off-hours is limited in many Emergency departments (EDs). Clinician performed point-of-care ultrasound (POCUS) is increasingly used by emergency physicians as a bedside tool to evaluate suspected appendicitis. The purpose of this study is to evaluate the test characteristics of emergency physician performed POCUS to diagnose appendicitis in a Canadian ED. Methods: A pragmatic, retrospective chart review was performed on all patients for whom a POCUS was performed to diagnose appendicitis at St. Joseph’s Healthcare Hamilton in Ontario from December 1, 2010 to December 4, 2015. All POCUS scans were performed by physicians with Registered Diagnostic Medical Sonographer (RDMS) credentials or resident physicians undergoing POCUS fellowship training. All scans were over-read by RDMS credentialed faculty and subject to a rigorous quality assurance (QA) process. POCUS findings and patient outcomes were reported. Results: A total of 90 patients were included in the study. 24 patients were diagnosed with appendicitis on POCUS. Ultimately, 18 were diagnosed with appendicitis through formal imaging, laparoscopy, and pathology. The sensitivity and specificity for POCUS to diagnose appendicitis was found to be 69.2% (95% CI, 48.1%-84.9%) and 90.6% (95% CI, 80.0%-96.1%) respectively. Conclusion: Bedside ultrasound is a reliable imaging modality for ruling in acute appendicitis. In cases where POCUS is negative or indeterminate for appendicitis, further imaging should be obtained as clinical suspicion warrants. The use of POCUS has the potential to reduce patient exposure to ionizing radiation and decrease the costs of obtaining CT scans, while hastening the process of achieving definitive management through earlier surgical consultation.

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