Initial evaluation of a trauma patient using an ultrasound

ABSTRACT

Bedside ultrasonographic examination is known to be a quick, noninvasive, cost-effective, repeatable, and harmless diagnostic modality. It can be a powerful tool for clinicians, especially in time-dependent situations including trauma. Focused assessment with sonography in trauma (FAST) has been established as a protocol especially specifically for hemodynamically unstable patients with blunt abdominal trauma. The physiologic priority of airway, breathing, circulation, and disability (ABCD) of injured patients should be assessed using a multi-systemic, multi-focused, problem-based, and point-of-care ultrasound as an extension of physical examination. This ultrasound-enhanced trauma life support, so called FAST-ABCD, can provide a great deal of important information for helping the primary physician in critical decision-making by systemically combining the airway, lung, cardiovascular, abdominopelvic, orbital, and transcranial ultrasound. Additionally, it can provide information on airway patency, guidance of endotracheal intubation and cricothyroidotomy, lung contusion, limited hemodynamics, differential diagnosis of shock, intracranial hypertension, and even more extensively on a secondary survey from head to toe. The indications for the utility of ultrasound in trauma continue to evolve beyond FAST. FAST-ABCD could be incorporated into advanced trauma life support by obtaining more evidence through more studies worldwide.