Trauma

Case from SonoSpot: Topics in Bedside Ultrasound

25 yo male was found unresponsive per bystanders. Upon EMS arrival he was noted to have multiple stab wounds to the upper extremities and chest. Initial set of vitals revealed tachycardia without hypotension. Patient was intubated at the scene “for airway protection”. Mechanically ventilated upon ED arrival with the following vitals: BP 135/90 mmHg, HR 105 BPM, respirations 16/min, SpO2 100%, T 35.8 C. GCS 3T. During secondary survey found to have one stab wound to the left anterior chest (inferior to the nipple), and second stab wound to the right posterior chest (lateral to the inferior aspect of the scapula). Additional two stab wounds to both shoulders were superficial and were no longer bleeding. No apparent abdominal (wall) injuries were noted. Abdomen was non-distended and soft.



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What to Know

1. List the indications, contraindications, and limitations of CUS in trauma.
2. Describe clinically relevant sonographic anatomy from the clavicles to the pelvis.
3. Perform a trauma CUS protocol to evaluate for hemoperitoneum, hemopericardium, hemothorax, and pneumothorax.
4. Recognize normal, and subtle to obvious pathologic trauma CUS findings.
5. Estimate patient volume status by visualizing inferior vena cava size and respiratory variability.

What to Read: Introduction to Bedside Ultrasound

Free iBook download Vol 1 and Vol 2

Chapter 1: EFAST by Phil Craven and Mike Mallin

Chapter 22: SUSS IT by Casey Parker and James Rippey

Test Yourself
Reading Quiz 

Where to Learn More

US Podcasts
Ocular Light Relex by Jacob Avilla 2015
EFAST by Cliff Reid 7/9/2013
Advanced Trauma US by Matt and Mike 12/17/2013 

ACEP US Section Resources
ACEP Sonoguide Trauma Page by Rob Reardon and Beatrice Hoffmann
ACEP Trauma Test by Mike Stone, Rob Blankenship et al.
ACEP Trauma US IBook by Mike Stone, Bob Jones, and Rob Blankenship

SAEM Academy of EUS Resources
EFAST Narrated Lecture by Beth Cadigan
EFAST Narrated Lecture by Beth Cadigan with Embedded ED Puzzle Quiz 

Emergency Ultrasound by Geoff Hayden
Fast Lecture

Key Articles to Review and Discuss

1. Consensus. ACEP Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550–570.
2. Ultrasound E, Criteria I. ACEP Emergency Ultrasound Imaging Criteria Compendium.; 2006. Available at: http://www.acep.org/ultrasound/
3. Melniker L, Leibner E, McKenney M, Lopez P, Briggs W, Mancuso C. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227–235.
4. Ma OJ, Gaddis G, Norvell JG, Subramanian S. How fast is the focused assessment with sonography for trauma examination learning curve? Emerg Med Australas. 2008;20(1):32–37.
5. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med Off J Soc Acad Emerg Med. 2010;17(1):11–17.