Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽  
2016 ◽  
Vol 1 (3) ◽  
pp. 13-14
Author(s):  
Stuart Douglas, PGY4 ◽  
Joseph Newbigging, MD ◽  
David Robertson, MD
Keyword(s):  
Case Report ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Ultrasound Probe ◽  
Trauma Resuscitation ◽  
Highly Sensitive ◽  
Pouch Of Douglas

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2021 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

Ultrasound Detection of Pneumothorax Compared with Chest X-Ray and Computed Tomography Scan

2011 ◽  
Vol 77 (4) ◽  
pp. 480-483 ◽  
Author(s):  
Khanjan Nagarsheth ◽  
Stanley Kurek
Keyword(s):  
Ct Scan ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Chest Ct ◽  
Trauma Patients ◽  
X Rays ◽  
Thoracic Ultrasound ◽  
X Ray ◽  
Chest X Ray ◽  
Chest Ct Scan

Pneumothorax after trauma can be a life threatening injury and its care requires expeditious and accurate diagnosis and possible intervention. We performed a prospective, single blinded study with convenience sampling at a Level I trauma center comparing thoracic ultrasound with chest X-ray and CT scan in the detection of traumatic pneumothorax. Trauma patients that received a thoracic ultrasound, chest X-ray, and chest CT scan were included in the study. The chest X-rays were read by a radiologist who was blinded to the thoracic ultrasound results. Then both were compared with CT scan results. One hundred and twenty-five patients had a thoracic ultrasound performed in the 24-month period. Forty-six patients were excluded from the study due to lack of either a chest X-ray or chest CT scan. Of the remaining 79 patients there were 22 positive pneumothorax found by CT and of those 18 (82%) were found on ultrasound and 7 (32%) were found on chest X-ray. The sensitivity of thoracic ultrasound was found to be 81.8 per cent and the specificity was found to be 100 per cent. The sensitivity of chest X-ray was found to be 31.8 per cent and again the specificity was found to be 100 per cent. The negative predictive value of thoracic ultrasound for pneumothorax was 0.934 and the negative predictive value for chest X-ray for pneumothorax was found to be 0.792. We advocate the use of chest ultrasound for detection of pneumothorax in trauma patients.

scholarly journals Teaching Emergency Surgical Skills for Trauma Resuscitation-Mechanical Simulator versus Animal Model

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Jameel Ali ◽  
Anne Sorvari ◽  
Anand Pandya
Keyword(s):  
Animal Ethics ◽  
Porcine Model ◽  
Life Support ◽  
Surgical Skills ◽  
Advanced Trauma Life Support ◽  
Educational Effectiveness ◽  
Trauma Resuscitation ◽  
Suitable Alternative ◽  
Alternative Teaching ◽  
System 1

Background. Traditionally, surgical skills in trauma resuscitation have been taught using animal models in the advanced trauma life support (ATLS) course. We compare one mechanical model (TraumaMan simulator) as an alternative teaching tool for these skills. Method. Eighteen providers and 14 instructors performed four surgical procedures on TraumaMan and compared educational effectiveness with the porcine model. Evaluation was conducted (Likert system 1: very poor to 5: excellent). The participants indicated if TraumaMan was a suitable (scale 1: not suitable to 4: excellent) ATLS teaching model considering cost, animal ethics concerns, and other factors. Comments were solicited for both models. Results. Overall ratings for educational effectiveness of the 4 skills ranged from 3.58 to 4.36 for the porcine and 3.48 to 4.29 for the TraumaMan model. TraumaMan suitability was rated 3-4 (mean 3.38) by 84% participants. TraumaMan as a substitute for the porcine model was recommended by 85% participants. With no ethical or cost concerns, 44% students and 71% instructors preferred TraumaMan. Considering all factors, TraumaMan was preferred by 78% students and 93% instructors. Conclusions. TraumaMan is a suitable alternative to the porcine model and considering all factors it may be the preferred method for teaching ATLS emergency trauma surgical skills.

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

2013 ◽  
Vol 33 (6) ◽  
pp. 18-24 ◽  
Author(s):  
Stavros Gourgiotis ◽  
George Gemenetzis ◽  
Hemant M. Kocher ◽  
Stavros Aloizos ◽  
Nikolaos S. Salemis ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Life Support ◽  
Operative Management ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
Randomized Controlled Clinical Trials ◽  
Resuscitation Fluid ◽  
Crystalloid Solutions ◽  
Prehospital Trauma Life Support

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient’s current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

Prehospital Care and In-hospital Mortality of Trauma Patients in Iran

2014 ◽  
Vol 29 (5) ◽  
pp. 473-477 ◽  
Author(s):  
Mohammad Paravar ◽  
Mehrdad Hosseinpour ◽  
Mahdi Mohammadzadeh ◽  
Azade Sadat Mirzadeh
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Publication Type ◽  
Transport Time ◽  
Severe Injuries

AbstractIntroductionThe aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.MethodsThis study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.ResultsTwo thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).ConclusionIn-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.HosseinpourM, ParavarM, MohammadzadehM, MirzadehAS. Prehospital care and in-hospital mortality of trauma patients in Iran. Prehosp Disaster Med. 2014;29(5):1-5.

scholarly journals UJI DIAGNOSTIK SEDIAAN POTONG BEKU TUMOR PAYUDARA DI LABORATORIUM PATOLOGI ANATOMI PADANG

2015 ◽  
Vol 38 (1) ◽  
pp. 7
Author(s):  
Aswiyanti Asri ◽  
Susanto Winarko
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Breast Tumor ◽  
Frozen Section ◽  
Specific Test ◽  
Frozen Section Examination ◽  
Highly Sensitive ◽  
High Level ◽  
Histopathology Examination

AbstrakKanker payudara menempati urutan pertama tumor ganas pada wanita di Sumatera Barat dan merupakan penyebab kematian sebanyak 1.41% dari total kematian. Pemeriksaan potong beku menjadi salah satu pilihan dalam menegakkan diagnosis tumor payudara karena cepat dan akurasi yang cukup tinggi. Penelitian ini bertujuan untuk mengetahui akurasi sediaan potong beku pada tumor payudara yang didiagnosis di Laboratorium Patologi Anatomi di Padang, dengan konfirmasi histopatologi (blok parafin). Sebanyak 72 kasus tumor payudara yang dilakukan pemeriksaan potong beku, dikumpulkan dari laboratorium Patologi Anatomi RSUP Dr. M. Djamil dan RS Siti Rahmah Padang dari 1 Januari 2010 sampai dengan 31 Desember 2012. Data berupa hasil pemeriksaan potong beku dan histopatologi (blok parafin) dicatat, diolah dan dilakukan uji diagnostik dengan tabel kontingensi 2x2, kemudian dilakukan penghitungan sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, dan akurasi. Hasil uji diagnostik potong beku terhadap histopatologi pada kasus tumor payudara didapatkan sensitivitas 100%, spesifisitas 95,65%, nilai prediksi positif 98%, nilai prediksi negatif 100%, akurasi 98.6%. Pemeriksaan potong beku sangat sensitif dan spesifik yang sangat bermanfaat untuk diagnosis tumor payudara yang cepat dan akurat.AbstractBreast cancer is the most common cancer among female in West Sumatera and cause of 1.41% of the death. Frozen section examination of breast has been used as a diagnostic procedure because this method need less time and have high level of accuracy. The aim of this study is to evaluate the accuracy of frozen section examination with histopathologic confirmation.The study has been done retrospectively in 72 samples of breast tumor at the Anatomic Pathology of Dr.M.Djamil Public Hospital and Siti Rahmah Hospital Padang from January 1, 2008 to December 3, 2012. The result of frozen section and histopathology examination was collected and analyzed for counted the sensitivity and specificity value, positive predictive value, negative predictive value and accuracy value using contingency table 2 x 2. The result showed a 100% sensitivity, 95.65% specificity, 98% positive predictive value, 100% negative predictive value and 98.6% accuracy. Frozen section examination is a highly sensitive and specific test that can be useful for diagnostic choice of breast tumor and it is time less and accurate.

scholarly journals DIAGNOSTIC ACCURACY OF ULTRASOUND IN THE DETECTION OF PNEUMOTHORAX IN CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Danquale Vance Kynshikhar ◽  
Chaman Lal Kaushal ◽  
Ashwani Tomar ◽  
Neeti Aggarwal
Keyword(s):  
Emergency Department ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Chest Trauma ◽  
Accurate Diagnosis ◽  
Trauma Patients ◽  
Chest Ultrasound

Background: To study the diagnostic accuracy of ultrasound in the detection of pneumothorax in chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: By chest ultrasound, pneumothorax was detected in 15 of 24 patients. The sensitivity of chest ultrasound for the diagnosis of pneumothorax was 62.5%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 54.14% and accuracy was 75%. Conclusion: Chest ultrasound can play an important role in the emergency department aiding a physician for bedside rapid and accurate diagnosis of pneumothorax without interruption in the resuscitation process and without transferring the patient to the radiology section. Keywords: Ultrasound, CT, Pneumothorax

scholarly journals Evaluation of Chest CT Scan as a Screening and Diagnostic Tool in Trauma Patients with Coronavirus Disease 2019 (COVID-19): A Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hossein Abdolrahimzadeh Fard ◽  
Salahaddin Mahmudi-Azer ◽  
Sepideh Sefidbakht ◽  
Pooya Iranpour ◽  
Shahram Bolandparvaz ◽  
...  
Keyword(s):  
Ct Scan ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Cross Sectional Study ◽  
Chest Ct ◽  
Trauma Patients ◽  
Ct Scanner ◽  
Sectional Study ◽  
Cross Sectional ◽  
Chest Ct Scan

Background. The lack of enough medical evidence about COVID-19 regarding optimal prevention, diagnosis, and treatment contributes negatively to the rapid increase in the number of cases globally. A chest computerized tomography (CT) scan has been introduced as the most sensitive diagnostic method. Therefore, this research aimed to examine and evaluate the chest CT  scan as a screening measure of COVID-19 in trauma patients. Methods. This cross-sectional study was conducted in Rajaee Hospital in Shiraz from February to May 2020. All patients underwent unenhanced CT with a 16-slice CT scanner. The CT scans were evaluated in a blinded manner, and the main CT scan features were described and classified into four groups according to RSNA recommendation. Subsequently, the first two Radiological Society of North America (RSNA) categories with the highest probability of COVID-19 pneumonia (i.e., typical and indeterminate) were merged into the “positive CT scan group” and those with radiologic features with the least probability of COVID-19 pneumonia into “negative CT scan group.” Results. Chest CT scan had a sensitivity of 68%, specificity of 56%, positive predictive value of 34.8%, negative predictive value of 83.7%, and accuracy of 59.3% in detecting COVID-19 among trauma patients. Moreover, for the diagnosis of COVID-19 by CT scan in asymptomatic individuals, a sensitivity of 100%, specificity of 66.7%, and negative predictive value of 100% were obtained ( p value: 0.05). Conclusion. Findings of the study indicated that the CT scan’s sensitivity and specificity is less effective in diagnosing trauma patients with COVID-19 compared with nontraumatic people.

“A-OK”: Chest Radiograph during Primary Survey Facilitates Faster, More Accurate Endotracheal Tube Position in Injured Children

2019 ◽  
Vol 85 (5) ◽  
pp. 479-487
Author(s):  
Andrea N. Doud ◽  
Michaela Gaffley ◽  
Olivia Hostetter ◽  
Jennifer W. Talton ◽  
John K. Petty
Keyword(s):  
Endotracheal Tube ◽  
Life Support ◽  
Pediatric Trauma ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Primary Survey ◽  
Breath Sounds ◽  
Before And After ◽  
Chest X Ray ◽  
Baseline Characteristics

The Advanced Trauma Life Support algorithm recommends bedside confirmatory techniques to confirm correct endotracheal tube (ETT) depth, a critical component in the care of pediatric trauma patients. We hypothesized that bedside confirmatory techniques are inaccurate and that early chest X-ray (CXR) would overcome such inaccuracies, allowing for faster intervention of malpositioned ETTs. An “A-OK” algorithm of immediate CXR following intubation in injured children aged <16 years was implemented. Eligible patients the years before and after implementation were identified. The accuracy of bedside confirmatory techniques (use of length-based depths and auscultation of breath sounds) was assessed. Post-“A-OK” patients were compared with pre-“A-OK” controls regarding the speed of malpositioned ETTrepositioning. Twenty-eight post-“A-OK” cases and 23 pre-“A-OK” controls were identified. The groups did not differ in baseline characteristics. Bedside confirmatory techniques were accurate in only 61 per cent (length-based depth) and 58 per cent (auscultation of breath sounds) of patients. Time to ETT repositioning was significantly longer in pre-“A-OK” controls than in post-“A-OK” cases (35.2 ± 15.9 minutes vs 21.1 ± 11.8 minutes, P = 0.03). Bedside confirmatory techniques to determine ETT positioning are inaccurate in children. Inclusion of CXR in the primary survey is safe and allows for more rapid repositioning of malpositioned ETTs.

scholarly journals Two Methods for Rapid Serological Diagnosis of Acute Leptospirosis

2001 ◽  
Vol 8 (2) ◽  
pp. 349-351 ◽  
Author(s):  
Paul N. Levett ◽  
Songee L. Branch ◽  
Carol U. Whittington ◽  
Charles N. Edwards ◽  
Helene Paxton
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Immunoglobulin M ◽  
Serological Diagnosis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Rapid Assays ◽  
Igm Elisa ◽  
Highly Sensitive ◽  
Specialized Equipment

ABSTRACT Leptospirosis is a common and underdiagnosed zoonosis. Two rapid assays for serological diagnosis of acute leptospirosis in diagnostic laboratories, the immunoglobulin M (IgM)-dipstick assay and the indirect hemagglutination assay (IHA), were evaluated and compared with standard assays. Sera were examined from 104 patients admitted to a hospital for investigation in a leptospirosis diagnostic protocol. Specimens for serology were taken on days 1 and 4 of the patients' hospital stay. Antibodies were detected using an IgM-enzyme-linked immunosorbent assay (ELISA), microscopic agglutination test (MAT), an IgM-dipstick assay, and an IHA. Fifty-one patients were found to have leptospirosis. The sensitivity of the IgM-dipstick assay was 98%, its specificity was 90.6%, its positive predictive value was 90.9%, and its negative predictive value was 98%. The sensitivity of the IHA was 92.2%, its specificity was 94.4%, its positive predictive value was 95.9%, and its negative predictive value was 92.7%. The standard IgM-ELISA and MAT, were positive in the first samples tested from 67 and 55% of the cases, respectively, and the rapid IgM-dipstick assay and IHA were positive in 71 and 49%, respectively, in the first sample tested. Both rapid assays are highly sensitive and specific. Neither requires specialized equipment, and both are suitable for use in diagnostic laboratories.

Sign in / Sign up

Export Citation Format

Share Document