Slutzman Jonathan E, Arvold Lisa A, Rempell Joshua S, Stone Michael B, Kimberly Heidi H
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Emerg Med. 2014 Oct;47(4):427-9. doi: 10.1016/j.jemermed.2014.04.016. Epub 2014 May 27.
The focused assessment with sonography in trauma (FAST) examination is an important screening tool in the evaluation of blunt trauma patients.
To describe a case of a hemodynamically unstable polytrauma patient with positive FAST due to fluid resuscitation after blunt trauma.
We describe a case of a hemodynamically unstable polytrauma patient who underwent massive volume resuscitation prior to transfer from a community hospital to a trauma center. On arrival at the receiving institution, the FAST examination was positive for free intraperitoneal fluid, but no hemoperitoneum or significant intra-abdominal injuries were found during laparotomy. In this case, it is postulated that transudative intraperitoneal fluid secondary to massive volume resuscitation resulted in a positive FAST examination.
This case highlights potential issues specific to resuscitated trauma patients with prolonged transport times. Further study is likely needed to assess what changes, if any, should be made in algorithms to address the effect of prior resuscitative efforts on the test characteristics of the FAST examination.
创伤超声重点评估（FAST）检查是钝性创伤患者评估中的一项重要筛查工具。
描述一例钝性创伤后经液体复苏导致FAST检查阳性的血流动力学不稳定的多发伤患者。
我们描述了一例血流动力学不稳定的多发伤患者，在从社区医院转至创伤中心之前接受了大量液体复苏。到达接收机构时，FAST检查显示腹腔内有游离液体阳性，但剖腹手术时未发现腹腔积血或明显的腹腔内损伤。在本病例中，推测大量液体复苏继发的渗出性腹腔内液体导致FAST检查阳性。
本病例突出了转运时间延长的复苏创伤患者特有的潜在问题。可能需要进一步研究以评估在算法中应做出哪些改变（如果有的话）来解决先前复苏措施对FAST检查测试特征的影响。
