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Trauma Service / KMUH FAST or not? 100 victims of penetrating torso trauma assessed by our trauma teams. 48 stab wounds, 51 gunshot wounds, and 1 puncture wound.. The overall accuracy of the US examination in penetrating torso trauma was 87%, with a sensitivity of 64% and a specificity of 96%. The positive predictive value was 86% and negative predictive value was 87%... The US examination lacks sensitivity to be used alone in determining operative intervention…Rarely does US information contribute to the management of patients with penetrating abdominal injuries *A PROSPECTIVE EVALUATION OF ULTRASONOGRAPHY DIAGNOSIS OF PENETRATING ABDOMINAL INJURY Dror Soffer MD, Mark McKenney et al. Ann Emerg Med 2003 Trauma Service / KMUH FAST or not? 149 patients with suspicion for abdominal trauma were evaluated…leaving 134 patients for analysis. There were 111 true negative FAST exams, 5 true positives, 17 false negatives, and 2 false positives. Chi-square analysis showed significant discordance between FAST and CT (p0.001). Utilization of FAST as a screening tool for BAI in hemodynamically stable trauma patients results in under-diagnosis of intraabdominal injury… Patients with suspected abdominal trauma should undergo routine CT scanning. *Not So Fast! M.T. Miller, ND, M.D. Pasquale et al. J Trauma 2002 Trauma Service / KMUH Pitfall Operator-dependent: skill Reliable? Sensitivity Missed injuries Pelvic fluid Full Bladder Serial examination Delayed onset Subcutaneous emphysema Gas block Trauma Service / KMUH The new ABCs Admit Begin CT scan Trauma Service / KMUH 如何運用工具? When? Why? Why not? Trauma Service / KMUH DPL When 需立即作YES或NO決定時 Hemodynamic instability 需進行大手術但無CT 檢查時 Rare these days 意識不清但需排除腸道損傷時 Trauma Service / KMUH DPL Why Quick decisions Looking primarily for gross blood Trauma Service / KMUH DPL Why not 為侵襲性檢查 Possible complication 非治療性開腹手術比率過高 Non-therapeutic lap rate app 30%! 對穩定血行之病患並不適合 Trauma Service / KMUH FAST When 需立即作YES或NO