Ultrasound is an available, portable tool that is easy to use and can provide the clinician with essential information for patient care. The use of ultrasound as an extension of the physical examination in surgery has progressively increased over the last decade. This technology applies to a wide variety of surgical specialties and has become a routine tool for evaluating organ systems and for targeting areas for intervention. Table 3–1 summarizes the benefits and drawbacks of ultrasound.
Table 3–1Summary of Benefits and Drawbacks of Point-of-Care Ultrasound ||Download (.pdf) Table 3–1 Summary of Benefits and Drawbacks of Point-of-Care Ultrasound
High yield when used by the treating clinician
Operator dependent (although this can be addressed with training)
Limited by patient factors (e.g., obesity and subcutaneous air)
The surgeon using ultrasound must have both basic and specific expertise. This chapter intends to provide a basic summary of ultrasound applications for the general surgeon. It does not replace formal training, and it will not go into detail regarding specialty-based ultrasound such as vascular, endoluminal, thyroid, and breast ultrasound. Basics in the science of ultrasound technology, as well as operator functions, are also addressed in another chapter.
ABDOMINAL AND FOCUSED THORACIC ULTRASOUND
The use of ultrasound for the diagnosis of intra-abdominal injury was first described in 1992 by Tso et al.1 In that initial study, the authors demonstrated that focused abdominal ultrasound examination was both feasible and accurate for the evaluation of bleeding following blunt trauma.1 The Focused Assessment with Sonography for Trauma (FAST) examination was introduced later as the diagnostic test of choice in patients with penetrating injury around the heart, as well as to diagnose intra-abdominal bleeding in hypotensive patients after blunt trauma.2, 3, and 4 Authors quote a 100% specificity and sensitivity for the diagnosis of intra-abdominal fluid, and 99% positive predictive value for the diagnosis of fluid in the pericardium with FAST.4 Its utility has been widely recognized since, and in 1996 the FAST examination was added to protocols for Advanced Trauma Life Support (ATLS) training. Since then, ultrasound evaluation of the pleura for fluid and pneumothorax have also become commonplace in trauma. As clinician facility with ultrasound has progressed, limited point-of-care echocardiography has been proposed for the intensive care unit and has been more recently extended to the trauma bay as a useful hemodynamic monitor.5, 6, and 7
FOCUSED ASSESSMENT WITH SONOGRAPHY FOR TRAUMA (FAST)
The FAST ultrasound is a simple test to learn, as it can be effectively performed with limited scanning planes. It is important, however, to have knowledge of the relevant anatomy and to have a good understanding of the standard scanning planes. One should also keep in mind that modern grayscale (B-mode) ...