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Emergency ultrasound in adults with abdominal and thoracic trauma

Manoj Pariyadath, MD
Greg Snead, MD
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Since its appearance as a diagnostic tool during World War II, ultrasonography has gained an increasingly important role in the assessment of the trauma patient. The term "Focused Abdominal Sonography for Trauma" was coined in 1996 to describe a standard set of ultrasound examinations for the evaluation of injured patients. The meaning of the acronym was changed to Focused Assessment with Sonography for Trauma (FAST) a year later to reflect applications outside the abdomen.

The performance and interpretation of ultrasound examination in the patient with abdominal or thoracic trauma will be reviewed here. Trauma management, including management of abdominal and thoracic injuries, is discussed separately. (See "Initial management of trauma in adults" and "Initial evaluation and management of blunt thoracic trauma in adults" and "Initial evaluation and management of penetrating thoracic trauma in adults" and "Initial evaluation and management of blunt abdominal trauma in adults" and "Initial evaluation and management of abdominal gunshot wounds in adults" and "Initial evaluation and management of abdominal stab wounds in adults".)


Overview — Ultrasound provides an important initial screening examination in the adult trauma patient. However, ultrasound is not a replacement for the more sensitive imaging studies often needed to identify specific injuries in patients with concerning abdominal or thoracic symptoms or signs. Most such patients, if hemodynamically stable, undergo computed tomography (CT). Unstable patients with intraperitoneal hemorrhage identified by ultrasound generally proceed directly to laparotomy.

For unstable patients without an obvious source of bleeding and in whom the initial ultrasound examination is negative (ie, without intraperitoneal fluid), a diagnostic peritoneal tap, or angiography, may be needed depending upon the clinical scenario. As an example, ultrasound generally plays a more limited role in the evaluation of patients with significant pelvic fractures because it is less sensitive for detecting pelvic bleeding, cannot detect retroperitoneal bleeding, and cannot differentiate between blood and urine. The management of such patients is discussed separately. (See "Pelvic trauma: Initial evaluation and management", section on 'Initial management'.)

Ultrasound evaluation performed as part of the initial examination and resuscitation of the trauma patient is known as the Focused Assessment with Sonography for Trauma (FAST) [1,2]. The extended FAST examination (E-FAST) is used when views are added to evaluate for pneumothorax.

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Literature review current through: Nov 2017. | This topic last updated: Oct 21, 2016.
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