1) Focused Assessment with Sonography for Trauma (FAST) exam is useful for rapidly detecting fluid in trauma patients. Studies have found FAST to be more sensitive than chest X-ray or clinical exam alone in detecting hemothorax and pneumothorax. 2) Research has shown ultrasound to have higher sensitivity (88%) and specificity (100%) compared to chest X-ray (52% sensitivity, 99% specificity) for diagnosing pneumothorax. 3) Ultrasound signs like the sliding lung sign and seashore sign can help identify pneumothorax with reported sensitivities of 81-93% and specificities around 90%. FAST scanning takes less than a minute and

1. FOCUSED ASSESSMENT
SONOGRAPHY FOR TRAUMA
FAST- EFAST
Abdel H Noureldin
program director
Chairman scientific committee
Emirates society of Emergency Medicine
Tawam hospital Emergency Medicine residency program
ICEM – December -2012

3. 29 Y/O male hit
by a car
B/P 70/20,
P = 140,
RR IS 50

4. given
4000 ML of LR
2 units of (O positive)
with no change in
vitals

6. Anechoic structures

7. hyperechoic structures

8. Hypoechoic structures

9. acoustic shadow structures

10. ?

11. CURVED , LINEAR & PHASE

12. Looking at 1mm section of the body

17. Fast scan
 + scan at 250 ml of fluid In the abdomen.
 Survival was better in the FAST group.
 DPL decreased by 13%.
 CT decreased by 30%.
 Cost saving was about $450,000.

18. ATLS RECOMMEND
FAST
OR
DPL

25. Fast scan for
hemothorax
US was more sensitive
than chest x-ray.
Faster than chest x-ray (
1.3 vs. 14.2 min)

27. FAST SCAN FOR
PNEUMOTHORAX
ULTRASOUND IS
MORE SENSITIVE
THAN
CHEST X-RAY

32. CHEST, October , 2011
Zhang et al pooled 20 studies that compared ultrasound, chest X-ray, or both
against a reference standard (usually CT scan) for the diagnosis of
pneumothorax.
Chest X-ray had a pooled
sensitivity of 52% and specificity
99% for diagnosis of
pneumothorax.
Ultrasound’s pooled sensitivity
was 88% and specificity, 100%.

33. Annals of Emergency Medicine
Volume 50, Issue 3, Supplement , Pages S107-S108, September
2007
Adhikari S., Zeger W., Lomneth C., Meza J.
A total of 84 ultrasound examinations were performed, 42 with the
“normal lung,” and 42 with the “pneumothorax.” A sliding lung sign
was correctly identified in 39 scans, and the seashore sign was
correctly identified in 34 scans. THE SENSITIVITY AND
SPECIFICITY FOR THE SLIDING LUNG SIGN WAS 93% (95%
CI 85-100%) AND 90% (95% CI 81-99%), RESPECTIVELY. The
sensitivity and specificity for the seashore sign was 80% (95% CI
68-92%), and 83% (95% CI 72-94%), respectively. The average
time to complete the B-mode scan was 33 seconds, and the
average time to complete the M-mode scan was 22 second

34. Am Surg. 2011 Apr;77(4):480-4.
Nagarsheth K, Kurek S.
Department Surgery, University of Tennessee Graduate School of Medicine,
Knoxville, Tennessee, USA. Khanjan.Nagarsheth@gmail.com
79 patients there were 22 positive pneumothorax found by CT and of
those 18 (82%) WERE FOUND ON ULTRASOUND AND 7 (32%)
WERE FOUND ON CHEST X-RAY. THE SENSITIVITY OF THORACIC
ULTRASOUND WAS FOUND TO BE 81.8 PER CENT AND THE
SPECIFICITY WAS FOUND TO BE 100 PER CENT. THE SENSITIVITY
OF CHEST X-RAY WAS FOUND TO BE 31.8 PER CENT AND AGAIN
THE SPECIFICITY WAS FOUND TO BE 100 PER CENT. The negative
predictive value of thoracic ultrasound for pneumothorax was 0.934 and
the negative predictive value for chest X-ray for pneumothorax was
found to be 0.792. We advocate the use of chest ultrasound for
detection of pneumothorax in trauma patients.

46. CASES

47. 20 y/o was involved in
a fight
he was stabbed in the
upper back.

49. backwards Seatbelt Vid.mpeg

55. Thank you