Fast by nurses ppt.
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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 [email protected]
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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.
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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].
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METHODOLOGY
• Study design- Qualitative prospective study
• Performance centre - ED of JPN Apex Trauma Centre, AIIMS.
• Study duration-January to September 2011
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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.
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FAST
Focused Assessment by Sonography in Trauma
AUTLS
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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%)
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FAST Exam- Primary Views or Windows
1. Subxiphoid2. Right upper
quadrant (RUQ) 3. Left upper
quadrant (LUQ) 4. Suprapubic
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FAST Exam - RUQ
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FAST Exam - LUQ
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FAST Exam – Supra-pubic
Transverse view
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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
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Limitation: Inter-observer variability was not noted
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FAST: Strengths and LimitationsStrengths Rapid (~2 mins) Portable Inexpensive Technically simple, easy
to train (studies show competence can be achieved after ~30 studies)
Can be performed serially
Useful for guiding triage decisions in trauma patients
Limitations Does not typically
identify source of bleeding, or detect injuries that do not cause hemoperitoneum
Requires extensive training to assess parenchyma reliably
Limited in detecting <250 cc intraperitoneal fluid
Particularly poor at detecting bowel and mesentery damage (44% sensitivity)
Difficult to assess retroperitoneum
Limited by habitus in obese patients
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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.
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