Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Fast by nurses ppt.
1. A Prospective evaluation of “focused assessment with
sonography for trauma” done by Emergency Nurses and its
comparative analysis with radiologists performance in
identifying fluid during initial resuscitation of trauma
Bhoi S,SoniaChauhan, Geeta A,Shakuntla , Shoukkathali V,Sinha
Tej P, RK. Ramchandani
Deptt. of Emergency Medicine,J P N Apex Trauma Center,AIIMS
sonia_aiims@yahoo.co.in
2. Background
Ultrasound has been used in the early assessment
of abdominal trauma.
Emergency Ultrasound (EUS) helps the treating
clinician to identify emergent conditions thus
facilitating the rapid diagnosis and treatment of
critically ill patients
Point of care sonography training to Emergency
Nurses in India would facilitate multiple skill
hands especially in mass casualty incidents.
3. Objective
To determine the accuracy of emergency
nurses in detecting free fluid in abdomen
when compared to radiologist during primary
survey of trauma victims by focused
assessment with Sonography for trauma
[FAST] scan in the Emergency Department
[ED].
4. METHODOLOGY
• Study design- Qualitative prospective study
• Performance centre - ED of JPN Apex
Trauma Centre, AIIMS.
• Study duration-January to September 2011
5. The study subjects included emergency Nurses (EN)
who underwent training at 3-day workshop on
emergency sonography
They performed 10 supervised positive and negative
scans for free fluid.
The FAST scans were first performed by the EN’s and
then by radiology resident (RR).
Both were blinded to each other’s sonography
findings.
CT scan and laparotomy findings were used as gold
standard whichever was feasible.
Results were compared between both groups.
6. FAST
Focused
Assessment by
Sonography in
Trauma
AUTLS
7. FAST scan
Minimal amount of fluid in abdomen detectable
by USG ~ 200 - 650ml
High sensitivity in detecting hemoperitoneum
(63 -100% )
High specificity in detecting hemoperitoneum
(96 - 99%)100%)
Low sensitivity in detecting specific organ lesions
(<50%)
8. FAST Exam- Primary Views or
Windows
1. Subxiphoid
2. Right upper
quadrant (RUQ)
3. Left upper
quadrant (LUQ)
4. Suprapubic
12. Results
94 scans performed each by EN and RR were
analysed.
Mean age of the patients was 29 [2 - 85] years.
Out of 23 true positive patients 18 underwent CT
scan and exploratory laparotomy was done in 14
patients.
Sensitivity of FAST done by EN and RR was 90 %.
Specificity of FAST done by EN was 94.6 %Vs RR.
Positive predictive value and negative predictive
values were 81.8% and 97.2% respectively
13. Limitation: Inter-observer variability
was not noted
14. FAST: Strengths and Limitations
Strengths Limitations
Rapid (~2 mins) Does not typically identify
Portable source of bleeding, or detect
Inexpensive injuries that do not cause
hemoperitoneum
Technically simple, easy to Requires extensive training
train (studies show to assess parenchyma
competence can be achieved reliably
after ~30 studies)
Limited in detecting <250 cc
Can be performed serially intraperitoneal fluid
Useful for guiding triage Particularly poor at detecting
decisions in trauma patients bowel and mesentery
damage (44% sensitivity)
Difficult to assess
retroperitoneum
Limited by habitus in obese
patients
15. Conclusion
FAST scan performed by EN who are
trained in short course of ultrasonography
can be reliable and accurate when
comparable to qualified radiologist.
It can be helpful during crisis scenarios
e.g. Mass casualty incidents.