Savoia Paulo, Jayanthi Shri Krishna, Chammas Maria Cristina
Department of Radiology, Institute of Radiology, University of Sao Paulo School of Medicine Clinics Hospital, São Paulo, Brazil.
J Med Ultrasound. 2023 Jun 19;31(2):101-106. doi: 10.4103/jmu.jmu_12_23. eCollection 2023 Apr-Jun.
The main cause of death in traumas is hypovolemic shock. Physical examination is limited to detect hemopericardium, hemoperitoneum, and hemopneumothorax. Computed tomography (CT) is the gold standard for traumatic injury evaluation. However, CT is not always available, is more expensive, and there are transportation issues, especially in hemodynamically unstable patients. In this scenario, a rapid, reproducible, portable, and noninvasive method such as ultrasound emerged, directed for detecting hemopericardium, hemoperitoneum, and hemopneumothorax, in a "point of care" modality, known as the focused assessment with sonography for trauma (FAST) protocol. With decades of experience, spread worldwide, and recommended by the most prestigious trauma care guidelines, FAST is a bedside ultrasound to be performed when accessing circulation issues of trauma patients. It is indicated to hemodynamically unstable patients with blunt abdominal trauma, with penetrating trauma of the thoracoabdominal transition (where there is doubt of penetrating the abdominal cavity) and for any patient with the cause of the instability unknown. There are four regions to be examined in the traditional FAST protocol: pericardium (to detect cardiac tamponade), right upper abdominal quadrant, left upper abdominal quadrant, and pelvis (to detect hemoperitoneum). The called extended FAST (e-FAST) protocol also searches the pleural spaces for hemothorax and pneumothorax. It is important to know the false positives and false negatives of the protocol, as well as its limitations. FAST/e-FAST protocol is designed to provide a simple "yes or no" answer regarding the presence of bleeding. It is not intended to quantify the bleeding nor evaluate organ lesions due to its limited accuracy for these purposes. Moreover, the amount of bleeding and/or the identification of organ lesions will not change patient's management: Hemodynamically unstable patients with positive FAST must go to the operating room without delay. CT should be considered for hemodynamically stable patients.
创伤致死的主要原因是低血容量性休克。体格检查在发现心包积血、腹腔积血和血气胸方面存在局限性。计算机断层扫描（CT）是创伤评估的金标准。然而，CT并非总是可用，费用更高，且存在转运问题，尤其是对于血流动力学不稳定的患者。在这种情况下，一种快速、可重复、便携且无创的方法，如超声，以“床旁即时检测”模式出现，用于检测心包积血、腹腔积血和血气胸，即创伤超声重点评估（FAST）方案。凭借数十年在全球范围内积累的经验，并得到最具权威性的创伤护理指南的推荐，FAST是在评估创伤患者循环问题时进行的床旁超声检查。它适用于血流动力学不稳定且有钝性腹部创伤的患者、胸腹交界部位有穿透伤（怀疑穿透腹腔）的患者以及任何病因不明且血流动力学不稳定的患者。传统FAST方案中有四个区域需要检查：心包（检测心包填塞）、右上腹象限、左上腹象限和骨盆（检测腹腔积血）。所谓的扩展FAST（e-FAST）方案还会检查胸腔以寻找血胸和气胸。了解该方案的假阳性和假阴性以及其局限性很重要。FAST/e-FAST方案旨在就出血情况给出简单的“是或否”答案。它并非用于量化出血情况，也不是因其对这些目的准确性有限而评估器官损伤。此外，出血量大和/或器官损伤的识别并不会改变对患者的处理方式：FAST结果呈阳性且血流动力学不稳定的患者必须立即送往手术室。血流动力学稳定的患者应考虑进行CT检查。
