Ultrasound in Emergency Medicine.ppt

Ultrasound in Emergency Medicine Martin A. Bazi, MD The clinical application of ultrasonography by emergency physicians has greatly expanded over the past decade. The American College of Emergency Physicians (ACEP) has firmly supported the concept of emergency ultrasound. INDICATIONS Blunt or penetrating trauma to the torso 4 views Rt flank: hepatorenal space Lt flank: Perisplenic area Subcostal : pericardium Pelvic : retrovesical or retrouterine The FAST examination ?  The Focused Assessment with Sonography for Trauma is a rapid, bedside, ultrasound examination performed to identify intra-peritoneal haemorrhage or pericardial tamponade. FAST examines four areas for free fluid: Perihepatic hepato-renal space Perisplenic Pelvis Pericardium Perihepatic Scanning The hepatorenal space (pouch of Rutherford-Morison) is the most dependent part of the upper peritoneal cavity and small amounts of intra-peritoneal fluid may collect in this region first. Blood shows as a hypoechoic black stripe between the capsule liver and the fatty fascia of the kidney. The probe is placed in the right mid- to posterior axillary line at the level of the 11th and 12th ribs.? Perisplenic Scanning The left upper quadrant examination visualises the spleen and perisplenic areas. The transducer is placed on the left posterior axillary line region between the 10th and 11th ribs. Pelvic Scanning The pelvic examination visualises the cul-de-sac: the Pouch of Douglas in females and the rectovesical pouch in the male. It is the most dependent portion of the lower abdomen and pelvis, hence where fluid will collect. The transducer is placed midline just superior to the symphysis pubis. Pericardial Scanning The pericardial examination screens for fluid between the fibrous pericardium and the heart, and hence possible cardiac tamponade. The transducer is placed just to the left of the xiphisternum and angled upwards under the costal margin. Advanced