Hocus pocus: advanced point-of-care ultrasound from the trauma bay to the surgical ICU.

The management of the critically injured patient is reliant on a combination of clinical evaluation skills, knowledge of the disease process, and procedural capability. This is supplemented by diagnostic tools. Ultrasound use has rapidly evolved as one such diagnostic tool. The focused assessment by sonography in trauma (FAST) was the index ultrasound protocol for trauma but has since expanded to additional protocols to evaluate shock physiology and independent organ system function and to facilitate procedure techniques. This article reviews the currently applicable techniques relevant to the trauma patient, including regional protocols such as the FAST, extended FAST, and rapid ultrasound for shock and hypotension examinations; organ-system scans, including cardiac, lung, inferior vena cava, and transcranial ultrasound; and the role of ultrasound for various trauma-care procedures such as vascular access and nerve blocks.