The Focused Assessment With Sonography For Trauma (FAST) Examination And Pelvic Trauma: Indications And Limitations (Trauma CME) - $39.00
March 2016 (Volume 18, Number 3)
This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2A or 2B CME credits.
Pelvic trauma accounts for only 3% of all skeletal injuries but may have mortality as high as 45% in cases of severe trauma. Significant high-grade-mechanism trauma to the pelvis must always take the abdomen into consideration for evaluation. The focused assessment with sonography for trauma (FAST) examination has been shown to be a valuable tool in assessing the unstable trauma patient with blunt abdominal injury, though its diagnostic utility is much less well-defined than in primary pelvic trauma. This systematic review explores the utility and limitations of the FAST examination in patients with blunt pelvic trauma and discusses the timing for the examination during the trauma survey. Newer techniques for emergency department management of the unstable trauma patient are also addressed.
Excerpt From This Issue
You arrive at the trauma bay in the evening just as a 24-year-old man is brought in by ambulance following a scooter accident against a moving car. He arrives with spinal precautions, and EMS reports transient hypotension en route that resolved with a 500-cc bolus of normal saline. The paramedics add that he is complaining about severe pelvic and diffuse abdominal pain, and they noted tenderness on palpation, with deformity and ecchymosis of his entire right pelvis. EMS has bound his pelvis with a sheet. His blood pressure on arrival is 86 mm Hg and he is tachycardic, but IV fluids are running in. You wonder if a FAST would be helpful in this case, but do you have enough have time to perform one? Should you even consider a CT? How do you determine whether the hemodynamic instability is due to hemorrhage from a primary abdominal or pelvic source? Will he need to go to the operating room or interventional radiology?