Abstract
Background and objective: Handheld ultrasound, because of its light weight, size, rugged design, and relative simplicity of use is ideal for use on operational military deployment. These machines have been used in the diagnosis of a range of traumatic conditions including abdominal, thoracic, and extremity trauma in the hospital environment, yet few data exist on their use during military operations. This paper presents experience of handheld focused assessment with sonography for trauma (FAST) on operational military deployment.
Method: Over a two month period, handheld FAST was performed by a single surgeon during the circulation phase of the primary survey in trauma patients presenting to the British Military Hospital in Iraq.
Results: Fifteen from casualties underwent a FAST examination. Ten were victims of blunt trauma, two had received injuries anti-personnel mines, and three had penetrating injuries from ballistic trauma. There was one positive FAST, confirmed at laparotomy as bleeding from a liver injury. Thirteen scans were negative and remained negative on repeat FAST at 6 hours. One further patient with a negative FAST underwent laparotomy because of transectory, there was no intra-abdominal blood or fluid at surgery.
Conclusion: Handheld FAST is a valuable technique for investigating abdominal or thoracic bleeding in single or multiple casualty events on operational military deployment.
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Selected References
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- Boulanger B. R., Kearney P. A., Tsuei B., Ochoa J. B. The routine use of sonography in penetrating torso injury is beneficial. J Trauma. 2001 Aug;51(2):320–325. doi: 10.1097/00005373-200108000-00015. [DOI] [PubMed] [Google Scholar]
- Brooks A., Davies B., Connolly J. Prospective evaluation of handheld ultrasound in the diagnosis of blunt abdominal trauma. J R Army Med Corps. 2002 Mar;148(1):19–21. doi: 10.1136/jramc-148-01-04. [DOI] [PubMed] [Google Scholar]
- Brooks A., Davies B., Smethhurst M., Connolly J. Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J. 2004 Jan;21(1):44–46. doi: 10.1136/emj.2003.005438. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Buzzas G. R., Kern S. J., Smith R. S., Harrison P. B., Helmer S. D., Reed J. A. A comparison of sonographic examinations for trauma performed by surgeons and radiologists. J Trauma. 1998 Apr;44(4):604–608. doi: 10.1097/00005373-199804000-00008. [DOI] [PubMed] [Google Scholar]
- Dolich M. O., McKenney M. G., Varela J. E., Compton R. P., McKenney K. L., Cohn S. M. 2,576 ultrasounds for blunt abdominal trauma. J Trauma. 2001 Jan;50(1):108–112. doi: 10.1097/00005373-200101000-00019. [DOI] [PubMed] [Google Scholar]
- Dulchavsky S. A., Hamilton D. R., Diebel L. N., Sargsyan A. E., Billica R. D., Williams D. R. Thoracic ultrasound diagnosis of pneumothorax. J Trauma. 1999 Nov;47(5):970–971. doi: 10.1097/00005373-199911000-00029. [DOI] [PubMed] [Google Scholar]
- Dulchavsky S. A., Schwarz K. L., Kirkpatrick A. W., Billica R. D., Williams D. R., Diebel L. N., Campbell M. R., Sargysan A. E., Hamilton D. R. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma. 2001 Feb;50(2):201–205. doi: 10.1097/00005373-200102000-00003. [DOI] [PubMed] [Google Scholar]
- Dulchavsky Scott A., Henry Scott E., Moed Berton R., Diebel Lawrence N., Marshburn Thomas, Hamilton Douglas R., Logan James, Kirkpatrick Andrew W., Williams David R. Advanced ultrasonic diagnosis of extremity trauma: the FASTER examination. J Trauma. 2002 Jul;53(1):28–32. doi: 10.1097/00005373-200207000-00006. [DOI] [PubMed] [Google Scholar]
- Kirkpatrick Andrew W., Brown Ross, Diebel Lawrence N., Nicolaou Sawas, Marshburn Tom, Dulchavsky Scott A. Rapid diagnosis of an ulnar fracture with portable hand-held ultrasound. Mil Med. 2003 Apr;168(4):312–313. [PubMed] [Google Scholar]
- Kirkpatrick Andrew W., Hamilton Douglas R., Nicolaou Savvas, Sargsyan Ashot E., Campbell Mark R., Feiveson Alan, Dulchavsky Scott A., Melton Shannon, Beck George, Dawson David L. Focused Assessment with Sonography for Trauma in weightlessness: a feasibility study. J Am Coll Surg. 2003 Jun;196(6):833–844. doi: 10.1016/S1072-7515(02)01906-3. [DOI] [PubMed] [Google Scholar]
- Kirkpatrick Andrew W., Simons Richard K., Brown Ross, Nicolaou Savvas, Dulchavsky Scott. The hand-held FAST: experience with hand-held trauma sonography in a level-I urban trauma center. Injury. 2002 May;33(4):303–308. doi: 10.1016/s0020-1383(02)00017-7. [DOI] [PubMed] [Google Scholar]
- Ma O. J., Mateer J. R., Ogata M., Kefer M. P., Wittmann D., Aprahamian C. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma. 1995 Jun;38(6):879–885. doi: 10.1097/00005373-199506000-00009. [DOI] [PubMed] [Google Scholar]
- Maxwell-Armstrong C., Brooks A., Field M., Hammond J., Abercrombie J. Diagnostic peritoneal lavage analysis: should trauma guidelines be revised? Emerg Med J. 2002 Nov;19(6):524–525. doi: 10.1136/emj.19.6.524. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McKenney M. G., Martin L., Lentz K., Lopez C., Sleeman D., Aristide G., Kirton O., Nunez D., Najjar R., Namias N. 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma. 1996 Apr;40(4):607–612. doi: 10.1097/00005373-199604000-00015. [DOI] [PubMed] [Google Scholar]
- Rozycki G. S., Ochsner M. G., Jaffin J. H., Champion H. R. Prospective evaluation of surgeons' use of ultrasound in the evaluation of trauma patients. J Trauma. 1993 Apr;34(4):516–527. doi: 10.1097/00005373-199304000-00008. [DOI] [PubMed] [Google Scholar]
- Rozycki G. S., Ochsner M. G., Schmidt J. A., Frankel H. L., Davis T. P., Wang D., Champion H. R. A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma. 1995 Sep;39(3):492–500. doi: 10.1097/00005373-199509000-00016. [DOI] [PubMed] [Google Scholar]
- Sarkisian A. E., Khondkarian R. A., Amirbekian N. M., Bagdasarian N. B., Khojayan R. L., Oganesian Y. T. Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J Trauma. 1991 Feb;31(2):247–250. [PubMed] [Google Scholar]
- Sisley A. C., Rozycki G. S., Ballard R. B., Namias N., Salomone J. P., Feliciano D. V. Rapid detection of traumatic effusion using surgeon-performed ultrasonography. J Trauma. 1998 Feb;44(2):291–297. doi: 10.1097/00005373-199802000-00009. [DOI] [PubMed] [Google Scholar]
- Udobi K. F., Rodriguez A., Chiu W. C., Scalea T. M. Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma. 2001 Mar;50(3):475–479. doi: 10.1097/00005373-200103000-00011. [DOI] [PubMed] [Google Scholar]