Case RoundsCase RoundsPass the PointerPass the Pointer

Case RoundsCase RoundsPass the PointerPass the Pointer

Megan Leo, MDMegan Leo, MDMegan Leo, MDMegan Leo, MD

IntroductionIntroductionIntroductionIntroduction

FAST (Focused Assessment with FAST (Focused Assessment with

Sonography for Trauma)Sonography for Trauma)

Indication: Evaluation of a patient with Indication: Evaluation of a patient with

blunt or penetrating trauma to the chest blunt or penetrating trauma to the chest

or abdomenor abdomenObjective: to detect free intraperitoneal, Objective: to detect free intraperitoneal,

intrathoracic, and pericardial fluid in the intrathoracic, and pericardial fluid in the

setting of traumasetting of trauma

FASTFASTFASTFASTFour main areas are evaluated on Four main areas are evaluated on the FAST exam for free fluid, plus the FAST exam for free fluid, plus thoracic cavitythoracic cavity

RUQ (Right pleural space, Morrison’s RUQ (Right pleural space, Morrison’s Pouch)Pouch)

LUQ (Left pleural space, Subphrenic and LUQ (Left pleural space, Subphrenic and Splenorenal fossa)Splenorenal fossa)

Suprapubic (Males rectovesicular pouch, Suprapubic (Males rectovesicular pouch, Females pouch of douglas)Females pouch of douglas)Subxyphoid (Pericardium)Subxyphoid (Pericardium)

eFAST - thoracic ultrasound (pleural eFAST - thoracic ultrasound (pleural effusion, pneumothorax)effusion, pneumothorax)

OutlineOutlineOutlineOutline

ReviewReview

Where’s the Fluid?Where’s the Fluid?

Case RoundsCase Rounds

ReviewReviewReviewReview

ReviewReviewReviewReview

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Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

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Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

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Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

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Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

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Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

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Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

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Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?Where’s the Fluid?

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Case RoundsCase RoundsCase RoundsCase Rounds

Case 1Case 1Case 1Case 1

16 y/o male presents after a high speed 16 y/o male presents after a high speed

boda boda accidentboda boda accident

Blood pressure 65/palp, Heart Rate 130Blood pressure 65/palp, Heart Rate 130

skin cold, paleskin cold, pale

Case 1Case 1Case 1Case 1

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Case 1Case 1Case 1Case 1

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Case 1Case 1Case 1Case 1

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Case 1Case 1Case 1Case 1

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Case 1 ConclusionCase 1 ConclusionCase 1 ConclusionCase 1 Conclusion

16 y/o male presents hypotensive and 16 y/o male presents hypotensive and

tachycardic, showing signs of tachycardic, showing signs of shockshock

FAST exam + in ALL quadrantsFAST exam + in ALL quadrants

This patient died in the operating roomThis patient died in the operating room

Management = surgeryManagement = surgery

Case 2Case 2Case 2Case 2

25 y/o female presents with severe 25 y/o female presents with severe

lower abdominal pain.lower abdominal pain.

Blood pressure 90/50, Heart Rate 99Blood pressure 90/50, Heart Rate 99

HCG positiveHCG positive

Case 2Case 2Case 2Case 2

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Case 2Case 2Case 2Case 2

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Case 2Case 2Case 2Case 2

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Case 2 ConclusionCase 2 ConclusionCase 2 ConclusionCase 2 Conclusion

Positive FAST exam with free fluid in Positive FAST exam with free fluid in

the RUQ, LUQ, and pelvisthe RUQ, LUQ, and pelvis

Presumed ectopic pregnancyPresumed ectopic pregnancy

Management = surgicalManagement = surgical

Case 3Case 3Case 3Case 3

55 y/o male presents with abdominal 55 y/o male presents with abdominal

discomfort and increased abdominal size. discomfort and increased abdominal size.

He is also reports dark urine.He is also reports dark urine.

Blood Pressure 110/70, Heart Rate 98Blood Pressure 110/70, Heart Rate 98

Case 3Case 3Case 3Case 3

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Case 3 ConclusionCase 3 ConclusionCase 3 ConclusionCase 3 Conclusion

55 y/o male with end stage liver disease 55 y/o male with end stage liver disease

with cirrhosis and asciteswith cirrhosis and ascites

Diagnostic paracentesis negative for infectionDiagnostic paracentesis negative for infection

Diagnosed with constipation and discharged homeDiagnosed with constipation and discharged home

Case 4Case 4Case 4Case 4

45 y/o male presents in cardiac arrest 45 y/o male presents in cardiac arrest

after being found down in the streetafter being found down in the street

His family brings him to your clinic and His family brings him to your clinic and

you immediately note he is pulseless and you immediately note he is pulseless and

start CPRstart CPR

After 3 rounds of CPR you do an ultrasound of his heartAfter 3 rounds of CPR you do an ultrasound of his heart

Case 4Case 4Case 4Case 4

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Case 4 ConclusionCase 4 ConclusionCase 4 ConclusionCase 4 Conclusion

You stop CPR and break the news to his You stop CPR and break the news to his

family that he was not able to be revivedfamily that he was not able to be revived

Case 5Case 5Case 5Case 5

15 y/o male comes into your clinic with 15 y/o male comes into your clinic with

difficulty breathing and left lateral chest wall difficulty breathing and left lateral chest wall

pain after falling off his boda onto the edge of pain after falling off his boda onto the edge of

the cement curbthe cement curb

Blood Pressure 110/70, Heart Rate 102Blood Pressure 110/70, Heart Rate 102

Appears in pain but good color, dry skin, no tachypneaAppears in pain but good color, dry skin, no tachypnea

Case 5Case 5Case 5Case 5

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Case 5Case 5Case 5Case 5

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Case 5 ConclusionCase 5 ConclusionCase 5 ConclusionCase 5 Conclusion

No pneumothoraxNo pneumothorax

You confidently diagnose the boy with a You confidently diagnose the boy with a

rib contusion vs. small fracture and tell rib contusion vs. small fracture and tell

him to go home and resthim to go home and rest

Thank You!!!Thank You!!!Thank You!!!Thank You!!!