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I'm seeing conflicting indications and recommendations. For the purposes of board exams, do we do a FAST exam when the patient is stable or unstable, or both in the setting of blunt abdominal trauma?
FAST is meant for the unstable patient, as a decision tool of who should bypass CT and go to the OR. It's just not used that way anymore. For the most part, all trauma activations get a FAST.
FAST is meant for the unstable patient, as a decision tool of who should bypass CT and go to the OR. It's just not used that way anymore. For the most part, all trauma activations get a FAST.
There should be no variability for the correct answer, there is only one answer to this. The FAST exam is meant to only have clinical utility in the unstable blunt trauma patient. It has minimal utility in all other indications. You know what you do if you find intra-abdominal fluid on FAST in a stable blunt trauma patient? You get a CT. You know what you do if the FAST is negative? You get a CT. How about if they have a GSW to the abd and are unstable? They go to the OR. How about if they have a GSW to the abd and are stable? Still go to the OR. What board prep material is saying otherwise?Thank you for the reply. This is what I'm seeing being reflected on board prep material. It looks like the age of when the algorithm questions were written are causing a variability in whether the correct answer is stable or unstable.
This reminded me of something I've been thinking about recently. Is the term "too unstable for CT", really even a thing anymore? Obviously patients who are coding, or are seconds from arresting (agonal breathing, hypoxia with progressively worsening bradycardia, etc.) are not going to scan, but I don't think anyone really cares about scanning those patients given that they are actively dying. I see this phrase thrown around all the time by colleagues or on EM:RAP where they are usually describing a run of the mill sick patient with soft BPs and maybe some respiratory distress. I can't think of a single time outside of trauma where I haven't gone to CT if I thought the patient really needed one regardless of stability. If I am really worried, I just start the patient on pressors and intubate them prior to going to the scanner, and then go with a crash cart and a nurse to watch them closely in CT.How does a FAST determine the need for a thoracotomy or a chest tube? I feel like I usually perform these when indicated based off history/exam prior to ever picking up a probe.
True. The reality is that CTs are usually performed pretty quickly and it rarely affects an outcome if there is a 5-10 minute delay prior to operative intervention. In our new ED remodel the CT is adjacent to the trauma rooms. I get equally frustrated when the patient doesn’t go immediately to the OR at times, but I’m also not the one operating. If a surgeon wants to know a little bit more before they cut other than that there is free fluid in the belly, then I’ll do my best to resuscitate them in the interim.
How does a FAST determine the need for a thoracotomy or a chest tube? I feel like I usually perform these when indicated based off history/exam prior to ever picking up a probe.
True. The reality is that CTs are usually performed pretty quickly and it rarely affects an outcome if there is a 5-10 minute delay prior to operative intervention. In our new ED remodel the CT is adjacent to the trauma rooms. I get equally frustrated when the patient doesn’t go immediately to the OR at times, but I’m also not the one operating. If a surgeon wants to know a little bit more before they cut other than that there is free fluid in the belly, then I’ll do my best to resuscitate them in the interim.