• Humans
• Point-of-Care Systems
• Abdominal Pain
• Ultrasonography/methods
• Tomography, X-Ray Computed
• Emergency Service, Hospital
• Abdomen/diagnostic imaging

• resident education
• surgical education
• trauma

• Humans
• Pilot Projects
• Curriculum
• Focused Assessment with Sonography for Trauma
• Ultrasonography
• Educational Status
• Clinical Competence
• Internship and Residency

• Humans
• Retrospective Studies
• Male
• Female
• Hemorrhage/therapy
• Hemorrhage/etiology
• France/epidemiology
• Adult
• Middle Aged
• Emergency Medical Services/methods
• Injury Severity Score
• Focused Assessment with Sonography for Trauma
• Wounds and Injuries/complications
• Wounds and Injuries/therapy

• AFAST
• POCUS
• canine
• free fluid
• ultrasound

• Humans
• Dogs
• Animals
• Point-of-Care Systems
• Prospective Studies
• Hospitals, Animal
• Standing Position
• Hospitals, Teaching
• Ultrasonography/veterinary
• Ultrasonography/methods

• Mississippi State University College of Veterinary Medicine Office of Research and Graduate Studies House Officer Internal Grant Program

• diagnostic imaging
• focused assessment with sonography for trauma
• point-of-care testing
• ultrasonography

• Abdominal injuries
• Emergency medical services
• Focused assessment with sonography for trauma
• Humans
• Nonpenetrating
• Wounds

• biomedical monitoring
• knee
• patella diameter
• patellar dislocation
• reliability
• reproducibility of results
• sulcus angle
• ultrasonography

This study aimed to evaluate the accuracy and outcomes of focused assessment with sonography for trauma (FAST) and determine the factors associated with true-positive FAST results.

The FAST results from 2016 to 2020 were retrospectively reviewed. Cases involving penetrating injury, transfer from other hospitals, age ≤ 16 years, prehospital arrest, and no confirmatory test were excluded. Intra-abdominal fluid was confirmed using computed tomography or operative findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Demographic data, injury characteristics, and outcomes were compared between true-positive and false-negative results. Logistic regression was used to identify the factors associated with true-positive results.

Of 2,758 patients, 163 and 2,595 patients showed positive and negative results, respectively. True positives were 135 and true negatives were 2325. The overall sensitivity, specificity, PPV, and NPV were 33.3%, 98.8%, 82.8%, and 89.6%, respectively. The sensitivity increased to 49.1% in patients with initial systolic blood pressure (SBP) ≤ 90 mmHg. The true-positive group showed a lower SBP and Glasgow Coma Scale score and a higher laparotomy rate than the false-negative group. However, mortality showed no significant difference. In logistic regression analysis, hollow viscus injury (1.820 [1.123–2.949], P=0.015) and the lowest SBP (0.988 [0.980–0.997], P=0.009) were associated with true-positive results compared to false-negative results.

The overall sensitivity of FAST was low; therefore, it should be performed in selected patients such as SBP ≤ 90 mmHg. Because of its low sensitivity and no influence on outcome, physicians should not rely solely on FAST.

• Abdominal injury
• FAST
• Prehospital ultrasound
• Time-to-surgery
• Trauma room

• Abdominal Injuries
• Ambulances
• Emergency Medical Services/methods
• Humans
• Prospective Studies
• Ultrasonography/methods

• Universitätsklinikum Magdeburg (8973)

Ultrasound training is an essential part of residency programs during emergency medicine rotations for first-year trainees (postgraduate year 1). The Focused Assessment with Sonography for Trauma examination used to assess for internal bleeding in trauma patients is one of the essential skills postgraduate year 1 residents must acquire during the emergency medicine rotation.

A prospective, longitudinal, observational study of postgraduate year 1 residents during a 2-month long emergency medicine rotation conducted from 1 April 2019 to 31 May 2021. The primary outcome was the mean difference between the hands-on Focused Assessment with Sonography for Trauma examination scores of the first week of the emergency medicine rotation and the same hands-on Focused Assessment with Sonography for Trauma examination scores of the last week of the emergency medicine rotation. All postgraduate year 1 residents had open access to the ultrasound machine to practice examining on other postgraduate year 1 residents or could use it on real patients under supervision of emergency medicine physicians.

A total of 91 postgraduate year 1 residents (65 male and 26 female) were recruited and submitted to the hands-on Focused Assessment with Sonography for Trauma test in both the first and last weeks of the rotation. The mean test score for the postgraduate year 1 residents in the first week was 7.81 (standard deviation = 2.11). The mean test score in the last week was 16.17 (standard deviation = 2.60). The primary outcome of this study was the score difference between the first and last weeks (mean = 8.35, 95% confidence interval = 7.73 to 8.94, p < 0.001, paired t-test).

Hands-on practical Focused Assessment with Sonography for Trauma training for postgraduate year 1 residents during emergency medicine rotations significantly improved their Focused Assessment with Sonography for Trauma test scores.

• Emergency medicine
• Focused Assessment with Sonography for Trauma (FAST)
• postgraduate year 1
• ultrasound

Background: The aim of this study was to compare the effectiveness of self-instructional-video (SIV) and classroom training method (CTM) in learning Focus-Assessment with Sonography-in-Trauma (FAST) among house officers (HO).

Method: A randomized controlled study involving house officers working in the university hospital in Malaysia was conducted where participants were randomized into SIV group (intervention) and CTM group (control). Each group had to undergo a 4 h hands-on training. The intervention group has undergone self-training using the video material without any facilitation while the control group received lecture and hands-on training with facilitators. Participants' performance was assessed using a validated Objective Structured Clinical Examination checklist for landmark identification and interpretation of images generated. Learning preference and confidence level were also assessed.

Result: A total of 33 HO were enrolled in this study. Marks obtained in image acquisition by the intervention and control were 25.3 (SD = 5.3) and 25.6 (SD = 2.3) p > 0.05, respectively. While in image interpretation, the mean score for the intervention and control group was 10.3 (SD 1.7) and 9.8 (SD = 1.7) p > 0.05, respectively. Overall performance assessment, showed the intervention group obtained 35.6 (SD = 5.9) compared to control 35.3 (SD = 3.4), p > 0.05. Based on pre-specified determinant these scores difference falls within the 10% of non-inferiority margin. The absolute difference between both groups was 0.3 (CI = −3.75 to 3.21, p = 0.871), which proves non-inferiority but not superiority. In terms of learning preference and confidence to perform FAST, most of the participants preferred the control group approach.

Conclusion: The SIV method is as effective as the CTM for learning FAST among the house officers and served as an alternative to classroom teaching. However, this technique needs improvement in promoting their confidence and preference. Perhaps incorporating a feedback session after going through the SIV would improve the confidence.

• education
• focused assessment with sonography in trauma
• self-directed learning
• self-instructional video
• simulation

The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS using an online survey.

A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carried out from November 30, 2020 to December 30, 2020 via an online web portal. Invitations for participation were sent via email to the medical directors of the European HEMS organizations including two reminding notes.

During the study period, 69 participants from 25 countries and 41 different HEMS providers took part in the survey. 96% (n = 66) completed the survey. POCUS was available in 75% (56% always when needed and 19% occasionally) of the responding HEMS organizations. 17% were planning to establish POCUS in the near future. Responders who provided POCUS used it in approximately 15% of the patients. Participants thought that POCUS is important in both trauma and non-trauma-patients (73%, n = 46). The extended focused assessment sonography for trauma (eFAST) protocol (77%) was the most common protocol used. A POCUS credentialing process including documented examinations was requested in less than one third of the HEMS organizations.

The majority of the HEMS organizations in Europe are able to provide different POCUS protocols in their services. The most used POCUS protocols were eFAST, FATE and RUSH. Despite the enthusiasm for POCUS, comprehensive training and clear credentialing processes are not available in about two thirds of the European HEMS organizations. Due to several limitations of this survey further studies are needed to evaluate POCUS in HEMS.

The online version contains supplementary material available at 10.1186/s13049-021-00933-y.

• Emergency medicine
• Helicopter emergency medical service
• Point-of-care ultrasound
• Pre-hospital care
• Survey

• Air medical transport
• Direct to operating room
• FAST
• Paramedic
• Prehospital
• Trauma

Point-of-care ultrasound (POCUS) is a focused examination, which is performed and interpreted at the bedside by the treating physician answering a specific clinical question. It is currently utilized as an essential adjunct to physical examination in many medical specialties. Recent advances in technology have made POCUS machines portable, affordable, and could be used with minimal training even by nonradiologists. This review aims to cover the fundamental physics of POCUS and its applications for diagnosing the acute abdomen in the primary health care including the most common causes encountered by family physicians. These are acute appendicitis, acute cholecystitis, renal colic, ectopic pregnancy, acute diverticulitis, bowel obstruction, and abdominal aortic aneurysm. We hope to encourage primary care physicians to incorporate POCUS in their routine clinical practice. We also highlight challenges encountered when using POCUS in the primary health care including limited availability and the need for proper training. Furthermore, we review the POCUS results when performed by primary health-care physicians. Integrating POCUS in primary health care empowers primary health-care physicians to provide high-quality, safe, and cost-effective care to the patients.

• Abdominal pain
• acute abdomen
• point-of-care ultrasound
• primary care

To evaluate a method aimed at teaching ultrasound techniques to medical students in emergency settings.

A prospective study conducted with 66 sixth-year undergraduate medical students. Students participated in theory and practicing sessions with a 5-hour load; knowledge acquisition was assessed through pre- and post-course and 90-day tests. A questionnaire were distributed to the students after course completion for theoretical and practical knowledge assessment.

Average pre-test grade in theoretical content evaluation was 4.9, compared to 7.6 right after course completion, and 5.9 within 90 days (p<0.001). Questions addressing technical aspects and image acquisition were mostly answered correctly; in contrast, questions related to clinical management of patients tended to be answered incorrectly. In practical evaluation, 54 students (81.8%) were able to correctly interpret images.

Ultrasound applicability and image acquisition techniques can be taught to medical students in emergency settings. However, teaching should be focused on technical aspects rather than clinical management of patients.

Point-of-Care Ultrasound (POCUS) is a useful diagnostic tool. Nevertheless, it needs proper training to reach its required level of competency. Educators who work in low-income countries find it difficult to purchase expensive training computer-based simulators. We aim in this communication to describe the methods to build up and use an efficient, simple, and cheap simulator which can be used for teaching POCUS globally.

It took our group 2 years to develop the simulator to its current form. The required material for the simulator includes a Kunafa knife, a carton gift box and its cover and colored play dough. The Kunafa knife with its blade is an excellent simulator for the small print convex array probe (3–5 MHz) and its ultrasound sections. It is useful to teach two important principles. First, the three basic hand movements used to control the ultrasound probe (fanning, tilting, and shifting). Second, the thin blade of the knife (1 mm thick) simulates the shape of the two-dimensional ultrasound images. The play dough is used to simulate different organs to be cut in different directions like the aorta and inferior vena cava.

The simulator was used to teach 88 fifth year medical students during the period of November 2017 to November 2018 at the College of Medicine and Health Sciences, UAE University. The simulator was valid, simple, portable, and sustainable. The students greatly enjoyed its use. The cost of the simulator is less than 10 US dollars.

Surgical educators who work in low-income countries are encouraged to develop their educational tools that are tailored to their own needs. Our simulator can help our colleagues who want to teach POCUS and cannot purchase expensive mannequins and computer-based simulators.

• Basic physics
• Fanning
• Learning
• Point-of-care
• Simulation
• Teaching
• Ultrasound

The use of point-of-care ultrasound (POCUS) by non-radiologists has dramatically increased. POCUS is completely different from the routine radiological studies. POCUS is a Physiological, On spot, extension of the Clinical examination, that is Unique, and Safe. This review aims to lay the basic principles of using POCUS in diagnosing intestinal pathologies so as to encourage acute care physicians to learn and master this important tool. It will be a useful primer for clinicians who want to introduce POCUS into their clinical practice. It will cover the basic physics, technical aspects, and simple applications including detection of free fluid, free intraperitoneal air, and bowel obstruction followed by specific POCUS findings of the most common intestinal pathologies encountered by acute care physicians including acute appendicitis, epiploic appendagitis, acute diverticulitis, pseudomembranous colitis, intestinal tuberculosis, Crohn’s disease, and colonic tumours. Deep understanding of the basic physics of ultrasound and its artefacts is the first step in mastering POCUS. This helps reaching an accurate POCUS diagnosis and avoiding its pitfalls. With increased skills, detailed and accurate POCUS findings of specific intestinal pathologies can be achieved and properly correlated with the clinical picture. We have personally experienced and enjoyed this approach to a stage that an ultrasound machine is always accompanying us in our clinical on calls and rounds.

• Appendicitis
• Basic physics
• Bowel obstruction
• Bowel perforation
• Diverticulitis
• Free fluid
• Inflammation
• Intestine
• Point-of-care
• Tuberculosis
• Tumour
• Ultrasound

Ultrasound is an extension of the clinical examination and its findings should be correlated with the clinical picture as a whole to be useful. Hereby, we report a unique negative diagnostic ultrasound finding in blunt abdominal trauma which was not reported before.

A 50-year-old obese man presented complaining of severe generalized abdominal pain and inability to pass urine of three days duration after he slipped on his abdomen. The abdomen was distended and tender all over. There was no blood on the urethral meatus. FAST scan showed significant intra-peritoneal fluid. The urinary bladder could not be seen. A Foley catheter was inserted which drained 3 L of clear urine. The abdominal distention became less. Repeated FAST scan was completely negative. A clinical diagnosis of major intra-peritoneal rupture of the urinary bladder was made. Trauma CT scan and laparotomy confirmed the diagnosis.

The change of a positive FAST to a negative FAST was diagnostic of a major intra-peritoneal urinary bladder rupture even before performing a trauma CT scan. When performing FAST in blunt abdominal trauma, it is more useful to perform FAST before inserting a urinary catheter and it is advised to repeat it.

• Injury
• Rupture
• Trauma
• Ultrasound
• Urinary bladder

• ATLS
• Advanced trauma life support
• In situ simulation
• Simulation training
• Trauma resuscitation
• Video-debriefing

• Adult
• Clinical Competence
• Female
• Germany
• Hospitals, Teaching
• Humans
• Injury Severity Score
• Male
• Patient Care Team/organization & administration
• Program Evaluation
• Resuscitation/education
• Retrospective Studies
• Time-to-Treatment/statistics & numerical data
• Tomography, X-Ray Computed
• Traumatology/education
• Videotape Recording

• EFAST
• Emergency medicine
• Emergency ultrasound
• Medical student
• OSCE
• Skill
• Trauma

The role of point-of-care ultrasound in mass casualty incidents (MCIs) is still evolving. Occasionally, hospitals can be destroyed by disasters resulting in large number of trauma patients. CAVEAT and FASTER ultrasound protocols, which are used in MCIs, included extremity ultrasound examination as part of them. The literature supports the use of ultrasound in diagnosing extremity fractures both in hospitals and MCIs. The most recent systematic review which was reported by Douma-den Hamer et al in 2016 showed that the pooled ultrasound sensitivity and specificity for detecting distal forearm fractures was 97% and 95% respectively. Nevertheless, majority of these studies were in children and they had very high heterogeneity. The portability, safety, repeatability, and cost-effectiveness of ultrasound are great advantages when treating multiply injured patients in MCIs. Its potential in managing fractures in MCIs needs to be further defined. The operator should master the technique, understand its limitations, and most importantly correlate the sonographic findings with the clinical ones to be useful. This editorial critically reviews the literature on this topic, describes its principles and techniques, and includes the author’s personal learned lessons so that trauma surgeons will be encouraged to use ultrasound to diagnose fractures in their own clinical practice.

• Fracture
• Point-of-care ultrasound
• Diagnosis
• Mass casualty incidents

• FAST
• perspectives
• trauma
• ultrasound

The indications of point-of-care ultrasound (POCUS) in the management of multiple trauma patients have been expanding. Although computed tomography (CT) scan of the orbit remains the gold standard for imaging orbital trauma, ultrasound is a quick, safe, and portable tool that can be performed bedside. Here we report two patients who had severe eye injuries with major visual impairment where surgeon-performed POCUS was very useful. One had a foreign body injury while the other had blunt trauma. POCUS was done using a linear probe under sterile conditions with minimum pressure on the eyes. Ultrasound showed a foreign body at the back of the left eye globe touching the eye globe in the first patient, and was normal in the second patient. Workup using CT scan, fundsocopy, optical coherence tomography, and magnetic resonance imaging of the orbits confirmed these findings. The first patient had vitreous and sub retinal haemorrhage and a full thickness macular hole of the left eye, while the second had traumatic optic neuropathy. POCUS gave accurate information concerning severe eye injuries. Trauma surgeons and emergency physicians should be trained in performing ocular ultrasound for eye injuries.

• Eye
• Injury
• Trauma
• Point-of-care
• Ultrasound

The initial management of a trauma patient is a critical and demanding period. The use of extended focused assessment sonography for trauma (eFAST) has become more prevalent in trauma rooms, raising questions about the real “added value” of chest X-rays (CXRs) and pelvic X-rays (PXR), particularly in haemodynamically stable trauma patients. The aim of this study was to evaluate the effectiveness of a management protocol integrating eFAST and excluding X-rays in stable trauma patients.

This was a prospective, interventional, single-centre study including all primary blunt trauma patients admitted to the trauma bay with a suspicion of severe trauma. All patients underwent physical examination and eFAST (assessing abdomen, pelvis, pericardium and pleura) before a whole-body CT scan (WBCT). Patients fulfilling all stability criteria at any time in transit from the scene of the accident to the hospital were managed in the trauma bay without chest and PXR.

Amongst 430 patients, 148 fulfilled the stability criteria (stability criteria group) of which 122 (82 %) had no X-rays in the trauma bay. No diagnostic failure with an immediate clinical impact was identified in the stability criteria group (SC group). All cases of pneumothorax requiring chest drainage were identified by eFAST associated with a clinical examination before the WBCT scan in the SC group. The time spent in the trauma bay was significantly shorter for the SC group without X-rays compared to those who received any X-ray (25 [20; 35] vs. 38 [30; 60] min, respectively; p < 0.0001). An analysis of the cost and radiation exposure showed savings of 7000 Є and 100 mSv, respectively.

No unrecognized diagnostic with a clinical impact due to the lack of CXR and PXR during the initial management of stable trauma patients was observed. The eFAST associated with physical examination provided the information necessary to safely complete the WBCT scan. It allowed a sensible cost and radiation saving.

• Diagnostic accuracy
• Imaging
• Resuscitation
• Severe trauma
• Stability
• Ultrasound

• Critical care
• Elderly
• Epigastric hernia
• Point-of-care
• Strangulated
• Ultrasound

• Humans
• Point-of-Care Systems
• Tropical Medicine/methods
• Ultrasonography/instrumentation
• Ultrasonography/methods