Page 52 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
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Chapter 2
Both the FALLS and RUSH protocol combine familiar US scans proven to be feasible in the prehospital setting. Although we are unaware of any reports, these protocols are potentially valuable in prehospital care.
ŠŠtraumatic shock
In traumatic shock, the (extended) FAST protocol may be used to detect a hemoperitoneum. A US image of a normal hepatorenal recess and one with a hemoperitoneum are displayed in Figure 2.7 and Figure 2.8. In abdominal trauma, its sensitivity and specificity are comparable between in-hospital and prehospital: 100% and 97.5% in-hospital and 90% and 99% prehospi- tal, respectively.2 The feasibility and efficiency of the extended FAST were also comparable, with no significant difference in US duration.22
In shocked blunt abdominal trauma patients, expeditious PoCUS should take a minimum amount of time. Clarke found that mortality increases by 1% for every three-minute delay of a necessary intervention.76,77 Unfortunately, false-negative results do occur and they do most frequently in scans performed early in the disease process.22,78 Therefore, when FAST
  Figure 2.7 Normal hepatorenal recess
A normal ultrasound image of the hepatorenal recess (Morison’s pouch). A phased-array cardiac transducer was used with the abdominal settings. The left arrow indicates the diaphragm. The right arrow indicates the hepatore- nal recess. The liver (L) is shown above this line and the right kidney (K) below.
 


























































































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