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EMEDPA

question for EM u/s gurus

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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. 

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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.

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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).  

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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?

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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!)

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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?

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