Moderator EMEDPA Posted September 5, 2018 Moderator Share Posted September 5, 2018 So I have been trying to utilize u/s a lot more, specifically fast exams. Any hints (other than major doses of narcs or procedural sedation) to get a patient with a significant abd injury and guarding to tolerate a fast exam? had a pt today with a lg retroperitoneal bleed after a fall who would have had a positive fast , but barely tolerated a physical exam. CT was grossly positive to my read. a fast exam would have probably saved 30 minutes. All the fasts I have done accept 1 have been normal because folks didn't really hurt all that much and permitted a good study. I'm guessing the answer is "you need to be meaner", but thought I would check. Link to comment Share on other sites More sharing options...
medic25 Posted September 17, 2018 Share Posted September 17, 2018 Typically you shouldn't require much pressure with your probe to perform a FAST, with the exception of the subcostal view. You might try lightening up your contact (combined with some judicious use of fentanyl). If they can't tolerate the subcostal view you can always try a different cardiac window like a PSLA so that you're visualizing the heart without applying abdominal pressure. FAST it typically pretty poor for retroperitoneal bleed (much, much better for intraperitoneal), so if it makes you feel better there is likely a good chance you wouldn't have seen much even with a good FAST. Link to comment Share on other sites More sharing options...
SERENITY NOW Posted September 17, 2018 Share Posted September 17, 2018 Lots and lots of gel is key. I often squirt a whole cup of gel on the anterior abdomen before starting the exam, then I scoop up plenty onto the probe for each individual scan. You wouldn't have to press on the abdomen at all if you have enough gel contiguous with the transducer. The exception as noted above is the subxiphoid view (agree with switching to PSL if they're too tender). Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 17, 2018 Author Moderator Share Posted September 17, 2018 thanks! Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 17, 2018 Moderator Share Posted September 17, 2018 Agree with copious gel. If you feel you aren’t getting good views with copious gel and light touch, tweak the depth and focus. Which probe are you using? Phase array or curvilinear? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 18, 2018 Author Moderator Share Posted September 18, 2018 curvilinear Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 19, 2018 Author Moderator Share Posted September 19, 2018 not really a fast, but just threw the probe on a pregnant lady with known ectopic who presented hypotensive after methotrexate at another facility yesterday. belly full of blood. bingo! (lots of gel helped, thnx guys!) Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 20, 2018 Moderator Share Posted September 20, 2018 On 9/17/2018 at 7:00 PM, EMEDPA said: curvilinear 52 minutes ago, EMEDPA said: not really a fast, but just threw the probe on a pregnant lady with known ectopic who presented hypotensive after methotrexate at another facility yesterday. belly full of blood. bingo! (lots of gel helped, thnx guys!) Nice! Just saw using curvilinear. Could also try phase array as supposedly, not sure my eyes can detect the difference, it can provide more clarity by somehow providing better frame rate? Link to comment Share on other sites More sharing options...
just_nelle Posted October 11, 2018 Share Posted October 11, 2018 Looks like I was beat to the punch, but LOTS of GEL is your friend in this instance. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.