The Trauma Patient

 Physical exam has been found to be grossly inaccurate in the

setting of major trauma. One third of physical exams incorrectly
predicted or incorrectly excluded injury

Powell D, Bivins B, Bell R 1982

Intubated, altered consciousness, or distracting injuries

Trauma Care Provider
 The ultimate goal of the physician is to detect all organs injured.

 However, early management decisions depend on the rapid

identification of active hemorrhage (DPL - Root 1965)

 Chambers JA, Pilbrow WJ. Ultrasound in abdominal trauma: an

alternative to peritoneal lavage. Arch Emerg Med 1988; 5:26-33
Correlation between amount of intra-abdominal fluid
and thickness of hypoechoic stripe
Large R Hemothorax
Pelvic view
Subcostal 4 chamber view
Probe Locations for Focused Abdominal Sonography for Trauma
-FAST Exam -
Management of Blunt Abdominal Injuries using FAST

Blunt Abdominal Trauma

FAST Exam

Positive Negative

Stable Unstable Stable Unstable

CT Scan Laparotomy Observe DPL

Repeat FAST
CT Scan
A 17 year old student suddenly felt faint while in line in a
MacDonald Burger Restaurant. On arrival at triage, his
vital signs are as follows; Temp 36.5C, Pulse 96/min, BP
70/50 mmHg, Respiration 18/min. He was transferred to
resus and his BP was then measured as 90/70mm Hg. He
gave a history of having being kicked over his L lower
chest by his TaeKwonDo instructor 4 days ago. He could
not continue but the following few days continue his daily
sparring sessions without any untoward effects. On
examination his chest nad with equal breath sounds.
Abdominal exam was equivocal with mild deep tenderness
in the LHC
 Scenario 2

30 year old foreign seaman was involved in a fight in a pub. When EMTs
arrived at the scene and saw him in a hemodynamically stable condition
with a 2 cm stab wound over his left 3rd intercostal space just lateral to the
sternum. There was no active bleeding. On arrival at ED 20 minutes later,
his vitals are as follows, pulse 140/min, BP unrecordable, later 50/?? mm
Hg. His neck veins were distended.
Uses of US in ED patients
 General Surgery
 Vascular
 OBGYN
 Urology
 Trauma
 Cardiac
 Others
US in Emergency Medicine
 Limited ambition
 Focused or goal directed
 Answer specific questions
 Unstable patient
Use of Focused Ultrasonography in Emergency Medicine
 Evaluation and decision making in PEA cardiac arrest
 Assessment of volume status in evaluation of
undifferentiated hypotensive patient
 Trauma evaluation in a unstable patient
 The unstable patient with abdominal pain
 Assessment for urinary tract obstruction in patients
with acute flank pain
 Female patients with acute lower abdominal pain