Bloom Benjamin A., Gibbons Ryan C.
Temple University Hospital
Lewis Katz School of Medicine at Temple University
Traumatic injury is the leading cause of death among individuals younger than 45 years old . Eighty percent of traumatic injury is blunt with the majority of deaths secondary to hypovolemic shock . In fact, intraperitoneal bleeds occur in 12% of blunt trauma ; therefore, it is essential to identify trauma quickly. The optimal test should be rapid, accurate, and non-invasive. Historically, providers performed diagnostic peritoneal lavage (DPL) to detect hemoperitoneum. While extremely sensitive (96% to 99%) and specific (98%), DPL is an invasive procedure with a complication rate of 1% ,, . CT remains the gold standard for diagnosing intra-abdominal injuries detecting as little as 100 cc of intraperitoneal fluid. However, time delays and transportation out of the emergency department confound the evaluation of hemodynamically unstable patients. The implementation of point of care ultrasound has significantly impacted the evaluation and treatment of patients . Ultrasound has considerable advantages, including its bedside availability, ease of use, and reproducibility. Furthermore, it is non-invasive, employs no radiation or contrast agents, and is inexpensive. The use of ultrasound to detect intraperitoneal fluid was first described in Europe during the 1970s. However, widespread adoption in the United States did not occur until the 1990s. The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98% . In the subset of hypotensive trauma patients, the sensitivity of the FAST exam approaches 100%. Experienced providers perform the FAST exam in less than 5 minutes , and its use decreases time to surgical intervention, patient length of stay, and rates of CT and DPL. Presently, more than 96% of level 1 trauma centers incorporate FAST into their trauma algorithms as does Advanced Trauma Life Support (ATLS) . Recently, many institutions have introduced the Extended FAST (eFAST) protocol into their trauma algorithms. The eFAST examines each hemithorax for the presence of hemothoraces and pneumothoraces.
创伤性损伤是45岁以下人群的主要死因。80%的创伤性损伤为钝性损伤，大多数死亡是由低血容量性休克继发所致。事实上，12%的钝性创伤会发生腹腔内出血；因此，快速识别创伤至关重要。最佳检测方法应快速、准确且无创。过去，医护人员通过诊断性腹腔灌洗（DPL）来检测腹腔积血。虽然DPL极其敏感（96%至99%）且特异（98%），但它是一种侵入性操作，并发症发生率为1%。CT仍然是诊断腹腔内损伤的金标准，能够检测出少至100毫升的腹腔内液体。然而，时间延迟以及将患者转运出急诊科会干扰对血流动力学不稳定患者的评估。床旁超声的应用对患者的评估和治疗产生了重大影响。超声具有诸多优势，包括可在床边使用、操作简便且可重复性强。此外，它无创，无需使用辐射或造影剂，且成本低廉。20世纪70年代，欧洲首次描述了使用超声检测腹腔内液体的方法。然而，直到20世纪90年代，超声在美国才得到广泛应用。创伤重点超声评估（FAST）是一种为评估腹腔积血和心包积血而制定的超声检查方案。众多研究表明其敏感性在85%至96%之间，特异性超过98%。在低血压创伤患者亚组中，FAST检查的敏感性接近100%。经验丰富的医护人员进行FAST检查的时间不到5分钟，其应用可缩短手术干预时间、患者住院时间以及CT和DPL的使用率。目前，超过96%的一级创伤中心将FAST纳入其创伤诊疗流程，高级创伤生命支持（ATLS）也是如此。最近，许多机构已将扩展FAST（eFAST）方案纳入其创伤诊疗流程。eFAST检查每个半侧胸腔是否存在血胸和气胸。
