Theme 3 - Ultrasound in Emergency Medicine

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Ultrasound Scanning in the Emergency Department



As a keen bean with anything relating to Emergency Medicine, I took myself off to Cambridge to learn as much as I could surrounding Ultrasound and its use in Emergency Medicine.
Here is some of when I was taught on US Level 1. 


FAST Scan - Focussed Assessment with Sonography for Trauma

 Ultrasound examination performed at the time of presentation of a trauma patient
The main aim in a trauma patient, is to identify the presence of  intra-peritoneal free fluid (haemoperitoneum) allowing for an immediate transfer to theatre, CT or other. 

 It is a RULE IN test - you can not rule out haemoperitoneum with a FAST Scan
Many studies have shown that peritoneal free fluid will not be identified by ultrasonography until more than 500 mL is present

 When detecting Intraperitoneal Free fluid:
- Sensitivity of ~90% (range 75-100%) 
- Specificity of ~95% (range 88-100%) 


Where to Perform a FAST Scan


THE PELVIC CAVITY


  • Images taken across 2 planes - Vertical and Horizontal
  • AKA Suprapubic view
  • The most dependant peritoneal space in the SUPINE trauma patient
  • The Pouch of Douglas or Recto-Vesical space is explored for free fluid




PERICARDIAL SAC




  • Use to examine the Pericardium
  • The potential space between the visceral and parietal pericardium is examined for a Pericardial Effusion
  • Probe is usually placed in the Epigastric Region
  • However if unable to place in this region parasternal views may be used



RIGHT FLANK 



  • Commonly referred to as the Peri-Hepatic view
  • Four potential spaces are sequentially examined for the accumulation of free fluid
    • Hepatorenal Interface (Morrisons Pouch) 
    • Subphrenic 
    • Pleural Spaces


LEFT FLANK





  • Commonly referred to as the Perisplenic or Left Upper Quadrant vie
  • Four potential spaces are sequentially examine
    • Splenorenal Interface
    • Subphrenic
    • Pleural Spaces







Thank-you for reading todays whistle-stop tour on FAST Scanning



 Sources include:
1. https://radiopaedia.org/articles/focussed-assessment-with-sonography-for-trauma-fast-scan
2. https://www.rcem.ac.uk/docs/Training/1.14.5%20RCEM-EMUS-booklet%20(3).pdf



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