Emergency ultrasound in trauma patients

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Sonographic examination

The initial focus of sonographic examination was a single view of the hepatorenal fossa (Morison's pouch) [2]. It was soon realized that a more comprehensive examination of the abdomen improved detection of free fluid, however [4]. This included examinations of both upper quadrants, the paracolic gutters, and pelvis. In 1997, McGahan et al [4] documented that sonographic sensitivity for the detection of free fluid could be improved by having a full bladder. Often in traumatized patients a Foley

Free fluid

Free fluid typically appears as a hypoechoic region within the peritoneal cavity or pelvis and is usually linear or triangular in shape (Fig. 1). The shape of the fluid depends on its compression by the surrounding structures. For instance, in Morison's pouch, the fluid between the kidney and liver usually has a linear shape (see Fig. 1). Fluid that surrounds bowel often appears triangular. Fluid often accumulates at the site of injury but then flows throughout the abdomen and into the pelvis.

Solid organ injury

After the initial studies on the use of sonography in detecting organ injuries in the 1970s [1], more recent studies focused on the detection of free fluid [11], [12], [13]. A few recent studies have demonstrated the ability of sonography to detect parenchymal organ abnormalities directly. Rothhin et al [12] reported a sensitivity rate of 41.4% for the direct detection of solid organ injuries by sonography. McGahan et al [4] also reported a sensitivity rate of 41% detection in solid organ

Sonographic appearance of solid organ injuries

Much of the work on sonographic classification and appearance of solid organ injuries has been performed by McGahan et al [23], [24] and Richards et al [25], [26]. When identified, acute solid organ injuries are often echogenic on sonography. A diffuse heterogeneous echogenic pattern is the predominant pattern identified with splenic injuries (Fig. 4). A discrete hyperechoic or diffuse hyperechoic pattern is seen with hepatic injuries (see Fig. 2). Renal injuries are echogenic, with a

Summary

US will be used more frequently in the future for the evaluation of traumatized patients. Previously, the main focus of the sonographic examination was for the detection of free fluid. Unstable patients with free fluid often can be triaged to the operation room without further imaging tests. In patients who are more stable or in whom US results are negative, CT is required. Based on recent studies, sonography has a sensitivity rate of approximately 40% in direct detection of solid organ

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      Evaluate both paracolic gutters to detect early hemoperitoneum. From the right or left upper quadrant views, slide the transducer caudad to visualize the inferior pole of the kidney.9,10 This action may allow the detection of blood just beginning to spill over from the pelvis into the Morison pouch (see Fig. 2B, C).

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