Thoracic Ultrasound for Detecting
Pneumothraces
The Extended FAST (EFAST) Exam
Pneumothoraces (PTX) are found in 1/5 major
blunt trauma victims who are found alive. PTX are dynamic and become
life-threatening, especially when positive pressure ventilation is use and
during air medical transport at altitude. The purpose of this study was the
prospective evaluation of the usefulness of hand-held sonography in addition to
physical exam to detect PTXs during initial resuscitation of trauma victims.
225 patients were examined after traumatic
injuries. The median Injury Severity Score (ISS) was 14, 74% were men, the
median age was 37 years. Of the 225 patients examined, 207 were victims of
blunt trauma. Normal determinations could be made in under a minute, and 65 PTX
were identified in 52 patients. Occult PTXs were present in 14.6% of all
patients and 24.6% using chest CT scan as the "gold" standard.
Compared with CT scan, EFAST performed with
greater accuracy than chest xray. Two false-positives involving suspected
left-sided PTXs were the result of right mainstem intubation. With
repositioning of the ETT above the carina, the sonogram returned to normal.
This finding demonstrates a potential further use of EFAST in operational
environments where auscultation is difficult or impossible.
For more information, see:
Kirkpatrick AW, Sirois M, Laupland KB, Liu
D, et al.(2004). Hand-held thoracic sonography for dectecting post-traumatic
pneumothoraces: The extended focused assessment sonography for trauma
(EFAST). Journal of Trauma, 57,
288-295. [review prepared by Andrew Reimer BSN RN] |
