9/22/2014
Ultrasound in Trauma:
Past, Present and
Future
Adeyinka A. Adedipe MD
Division of Emergency Medicine
University of Washington
Objectives

How is bedside US is used to evaluate
trauma patients?

What are the advantages and limitations
of bedside US in trauma care?

What is new in US for trauma care?
The Past . . .
1
9/22/2014
Case 1: Big City, USA
26 year old male
– Restrained driver HRMVA
Obtunded
at scene w/prolonged
extrication
– HR: 118
EMS:
BP:88/67
RR:6
2 large IVs and intubation
Case 1: Big City, USA
Primary
Survey
– HR: 121 BP:85/53
RR:12 (bagged)
– 8.0 ETT
– Bilateral BS
– Weak femoral pulses/stable pelvis
– Pupils 3→2 bilaterally, MAE
Case 1: Big City, USA

Secondary Survey
– Abdominal tenderness
diffusely
– Ecchymosis on the chest,
abdomen and pelvis
– Gross deformity of left
leg
2
9/22/2014
. . . the FAST
Primary Indications
Identify
intraperitoneal hemorrhage
Identify
pericardial effusion
Identify
hemothroax
Main Views

Hepatorenal

Splenorenal

Suprapubic

Subxiphoid
3
9/22/2014
Hepatorenal Space
Hepatorenal

Identify:
– Diaphragm
– Liver
– Kidney
4
9/22/2014
Splenorenal Space
Splenorenal

Identify:
– Diaphragm
– Spleen
– Kidney
5
9/22/2014
Suprapubic
6
9/22/2014
Suprapubic

Identify:
– Bladder
– Uterus (+/-)
7
9/22/2014
Advantages
Sensitive
 Rapid
 Bedside Test
 Noninvasive
 Non-ionizing
 Repeatable

Limitations
Retroperitoneum
 Solid Organs
 Hollow viscous
 <500mL fluid
 Subacute hemorrhage

8
9/22/2014
The Present . . .
Case 2: Small Town, USA
26
year old male
– Stab wound to the anterior chest
Awake
and alert at scene
– HR: 118
EMS:
BP:88/67
RR: 20
2 large bore IVs
Case 2: Small Town, USA
Primary
Survey:
– HR: 118
BP:88/67
RR: 20
– Patent airway
– Bilateral BS
– Weak radial pulse
– MAE to command
9
9/22/2014
Case 2: Small Town, USA

2cm laceration to chest

Faint heart sounds

Radial pulse diminishes
with inspiration

Prominent neck veins
and upper torso
plethora
. . . the E-FAST
The Extended FAST
Emphasis
on identifying pericardial
hemorrhage
Identify
pneumothroax
10
9/22/2014
Subxiphoid
Subxiphoid

Below costal
margin

Scan through the
liver
Subxiphoid

Identify:
– Pericardium
– Right ventricle
– Left ventricle
11
9/22/2014
12
9/22/2014
Thoracic Views
Hemothorax

Begin at mid-axillary
line, below rib
margin

Slide superiorly
– above level of
diaphragm
13
9/22/2014
Pneumothorax

Midclavicular line,
2nd or 3rd intercostal
space
FIN
Normal Lung:
pleural slide and comet tail artifacts
14
9/22/2014
Pneumothorax:
loss of pleural slide
The Future . . .
Case 3: Remote Village,
Far Away Nation
26
year old male
– Kicked in the abdomen by a horse
Family
arranged for a cart to transport
the patient
– It’s taken them 5 days to get over the
mountain range
15
9/22/2014
Case 3: Remote Village
Primary
Survey
– HR: 118
BP: 88/67
RR: 24
– Patent airway
– Bilateral BS
– Weak radial pulse/stable pelvis
– Lethargic, but neuro intact
Case 3: Remote Village
Secondary
Survey
– Abdominal
tenderness diffusely
– Rebound and
guarding
– Ecchymosis around
the umbilicus
. . . the iFAST?
16
9/22/2014
TeleSonography
J Trauma, 2010
17
9/22/2014
Resuscitative US
J Trauma, 2009
J Trauma Acute Care Surg, 2014
Summary

FAST

E-FAST

i-FAST
References
Williams SR, et al The FAST and E-FAST in 2013: trauma ultrasonography:
overview, practical techniques, controversies and new frontiers.
Crit Care Clin. 2014
Patel NY, et al Focused assessment with sonography for trauma: methods,
accuracy, and indications Surg Clin North Am. 2011
Daniel K. Does This Adult Patient Have a Blunt Intra-abdominal Injury?
JAMA. 2012
Kirkpatrick AW, et al. Cost-effective remote iPhone-teathered telementored trauma
telesonography. J Trauma. 2010
Nunez, et al. Early prediction of massive transfusion in trauma: simple as ABC
(assessment of blood consumption)? J Trauma. 2009
Ferrada, P et al. Findings of a randomized controlled trial using limited transthoracic
echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay.
J Trauma Acute Care Surg. 2014
18
9/22/2014
FIN
19