New Perspectives for Modern Trauma Management – Lessons Learned from 25 Years FAST and 15 Years E-FAST

Joseph Osterwalder; Gebhard Mathis; Beatrice Hoffmann

doi:10.1055/a-0924-5455

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2019; 40(05): 560-583
DOI: 10.1055/a-0924-5455

Continuing Medical Education

New Perspectives for Modern Trauma Management – Lessons Learned from 25 Years FAST and 15 Years E-FAST

Neue Perspektiven für das moderne Trauma-Management – Lehren aus 25 Jahren FAST und 15 Jahren E-FAST

Joseph Osterwalder

¹Spital, Appenzell, Switzerland

,

Gebhard Mathis

²Gastroenterologie, Internistische Praxis, Rankweil, Austria

,

Beatrice Hoffmann

³Emergency Department, Harvard Medical School Department of Emergency Medicine Beth Israel Deaconess Medical Center, Boston, United States

› Author Affiliations

Abstract

E-FAST (Extended-Focused Assessment with Sonography for Trauma) is now a widely utilized and internationally recognized standard exam in trauma care. It is highly accepted by emergency physicians and trauma surgeons alike. Thanks to the popularity of PoCUS (point-of-care ultrasound), it has continued to evolve over the last years and can now improve trauma diagnosis at all stages of the primary ABCDE. This review article summarizes key observations made over recent years and also highlights the extension of FAST into E-FAST in the context of PoCUS and CT developments for modern trauma management. Time has come to learn the lessons from 25 years of FAST and 15 years of E-FAST. We should redefine and position ultrasound in the primary ATLS survey (Advanced Trauma Life Support) on two levels: 1. Basic ATLS with new clinical questions, six additional abdominal image sections and one or more follow-up examinations depending on the clinical situation, and 2. Advanced ATLS with ultrasound applications for the entire trauma ABCDE.

Zusammenfassung

Der E-FAST (Extended-Focused Assessment with Sonography for Trauma) ist heute ein international anerkannter Standard, hoch akzeptiert und hat eine breite Anwendung bei Notfallmedizinern und Trauma-Chirurgen gefunden. Dank der Popularität von PoCUS (Point-of-care-Ultraschall) hat er sich über die letzten Jahre weiterentwickelt und kann die Trauma-Diagnostik auf allen Stufen des primären ABCDE verbessern. Dieses Review fasst die wichtigsten Erkenntnisse der letzten Jahre zusammen und zeigt die Erweiterung und den Stellenwert des E-FAST im Kontext der fokussierten PoCUS- und CT-Bewegung für das moderne Trauma-Management auf. Es ist höchste Zeit, dass wir die Lehren aus 25 Jahren FAST und 15 Jahren E-Komponente ziehen und den Ultraschall in der primären ATLS-Phase (Advanced Trauma Life Support) neu auf 2 Stufen definieren und positionieren: 1. Basisteil mit neuen Fragestellungen, 6 zusätzlichen abdominalen Bildschnitten sowie je nach Situation 1 oder mehrere Verlaufsuntersuchungen und 2. Aufbauteil mit Ultraschallapplikationen für das ganze Trauma-ABCDE.

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References

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