RESUMO
BACKGROUND: The focused abdominal sonogram for trauma (FAST) has been used by surgeons and emergency physicians (CLIN) to screen reliably for hemoperitoneum after trauma. Despite recommendations for "appropriate training," ranging from 50 to 400 proctored examinations, there are no supporting data. METHODS: We prospectively examined the initial FAST experience of CLIN in detecting hemoperitoneum by using diagnostic peritoneal lavage, computed tomography, and clinical findings as the diagnostic "gold standard." RESULTS: 241 patients had FAST performed by 12 CLIN (average, 20/CLIN; range, 2-43); 51 patients (21.2%) had hemoperitoneum and 17 patients (7.1%) required laparotomy. Initial experience with FAST by CLIN produced 35 true positives, 180 true negatives, 16 false negatives, and 3 false positives; sensitivity, 68%; specificity, 98%. Initial error rate was 17%, which fell to 5% after 10 examinations (chi2; p < 0.05). CONCLUSION: Previous recommendations for the number of proctored examinations for individual nonradiologist clinician sonographers to develop competence are excessive.
Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Hemoperitônio/diagnóstico por imagem , Radiologia/educação , Ultrassonografia/normas , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/diagnóstico , Adulto , Erros de Diagnóstico/estatística & dados numéricos , Medicina de Emergência/educação , Feminino , Humanos , Escala de Gravidade do Ferimento , Aprendizagem , Masculino , Lavagem Peritoneal , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Vermont , Ferimentos não Penetrantes/classificaçãoRESUMO
We present the case of a 34-year-old woman with cocaine-associated chest pain and hypersomnulence, who, because of her inability to report chest pain, and her comfortable appearance, was admitted to telemetry for a diagnosis of low-probability rule-out myocardial infarction. Her chest pain was incompletely relieved, and she subsequently was transferred to the intensive care unit and ruled in for myocardial infarction. We discuss the clinical syndrome of cocaine-related depressed level of consciousness, and its relationship to evaluation of cocaine-related chest pain.
