From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment.

Ultrasound is a ubiquitous and versatile diagnostic tool. In the setting of acute injury, ultrasound enhances the basic trauma evaluation, influences bedside decision-making, and helps determine whether or not an unstable patient requires emergent procedural intervention. Consequently, continued education of surgeons and other acute care practitioners in performing focused emergency ultrasound is of great importance. This article provides a synopsis of focused assessment with sonography for trauma (FAST) and the extended FAST (E-FAST) that incorporates basic thoracic injury assessment. The authors also review key pitfalls, limitations, controversies, and advances related to FAST, E-FAST, and ultrasound education.

Clinician-performed ultrasound in hemodynamic and cardiac assessment: a synopsis of current indications and limitations.

Accurate hemodynamic and intravascular volume status assessment is essential in the diagnostic and therapeutic management of critically ill patients. Over the last two decades, a number of technological advances were translated into a variety of minimally invasive or non-invasive hemodynamic monitoring modalities. Despite the promise of less invasive technologies, the quality, reliability, reproducibility, and generalizability of resultant hemodynamic and intravascular volume status data have been lacking. Since its formal introduction, ultrasound technology has provided the medical community with a more standardized, higher quality, broadly applicable, and reproducible method of accomplishing the above-mentioned objectives. With the advent of portable, hand-carried devices, the importance of sonography in hemodynamic and volume status assessment became clear. From basic venous collapsibility and global cardiac assessment to more complex tasks such as the assessment of cardiac flow and tissue Doppler signals, the number of real-life indications for sonology continues to increase. This review will provide an outline of the essential ultrasound applications in hemodynamic and volume status assessment, focusing on evidence-based uses and indications.

Spinal cord lipid levels in a porcine model of spinal cord decompression sickness.

Spinal cord lipid content was analyzed in 50 pigs that had experienced a simulated dive known to produce 20-80% incidence of neurologic decompression sickness (DCS). Using air and heliox as breathing mixtures, these animals underwent chamber dives ranging from 200-250 feet of seawater (fsw). These dives were designed to generate spinal cord DCS, which was detected by observing the animals for gross neurologic deficits. Using a standardized method, cylindrical samples of cord were cut from different spinal levels and analyzed for total lipid (TL) content, which produced two cervical, three thoracic, and two lumbar samples. All areas with gross hemorrhage were also sampled. The range of TL (mean) in milligrams per gram from the cervical, thoracic, and lumbar regions were 118-679 (319), 140-635 (366), and 109-658 (307), respectively. Although this implies that TL varies markedly between cords, values within each cord were fairly consistent (+/- 20% from cord mean). The difference in TL values between cord regions with and without hemorrhage was not significant (P > 0.1). This reveals that increased spinal cord TL levels, together with their presumed dissolved inert gas, do not play a major role in the location or incidence of spinal cord hemorrhages in pigs with clinical signs of spinal cord DCS.