Review
Trauma Ultrasound

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Abstract

Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

Section snippets

Hemopericardium

Blood in pericardial spaces in a trauma patient signifies presence of cardiac, pericardial or aortic root injuries, which can be in the form of contusions, lacerations or vascular trauma. Hemopericardium appears as an anechoic or hypo-echoic band within the pericardial space (Fig. 7). On the subxyphoid pericardial view, anterior pericardial fluid is seen between the left lobe of the liver and the right ventricle. Hemopericardium may cover the cardiac apex and locates within the posterior

Pitfalls and Limitations of Trauma Ultrasound

Although ultrasound has many advantages, such as non-invasiveness, portability, wide availability, repeatability and lack of ionizing radiation, several limiting factors need to be considered when performing trauma ultrasound. Technical limitations are those related to machine, scanning techniques and environment, nature of ultrasound and ultrasound operators. Non-technical factors are related to diseases/conditions and patients.

Image quality and scanning technique affect the accuracy of FAST.

Conclusions

Ultrasound plays a significant role in the rapid detection of life-threatening conditions such as hemopericardium, hemoperitoneum, hemothorax and pneumothorax and is routinely used in the initial phase of ATLS. A secondary survey with ultrasound, especially in patients with a negative initial scan, may reveal findings of specific torso injuries that could potentially expedite the next imaging test (such as contrast-enhanced CT scan) and guide appropriate protocol selection. Evaluation of the

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