Case 1: A 32 y/o M motorcyclist struck the side of a moving motor vehicle at high speed, was thrown 15 feet, and transiently lost consciousness per bystanders.  Prehospital vital signs were as follows: P: 120, BP: 100/palpitation, SpO2: 95%, RR: 25, GCS 9/15.  In the Emergency Department, the patient was A&Ox3 with a GCS of 15 and labored respirations.  The patient reported left shoulder pain and shortness of breath.  Initial ED vitals: HR 125, RR 25-30, SpO2 97% RA, blood pressure nonpalp by automated cuff, with no radial pulses and faint femoral pulses.  The patient’s airway was intact and b/l breath sounds were present.  Providers noted mild anterior chest tenderness without ecchymosis or deformity.  A left shoulder joint dislocation was noted.  US performed:

What ultrasound exam was performed above and what are the significant findings?

How effective is the FAST exam?  What is the sensitivity and specificity?

Case 2: The same patient above presents to your trauma bay:

What is the finding on this EFAST?  How effective is ultrasound in detecting this pathology?

Case 3: Same motorcycle patient presents and the following ultrasound is performed:

What condition is seen on this eFAST?

What’s the epidemiology and mechanism of this type of injury?

What is the sensitivity and specificity of transthoracic ultrasound in the detection of hemopericardium? 

What is the management of the patient above? 

What’s your airway management for this patient? 






References (back to top)

1) Rozycki, G.S.; Ochsner, M.G.; Feliciano, D.V.; et al. Early Detection of hemoperitoneum by ultrasound examination of the right upper quadrant: a multicenter study. J Trauma. 45(1998), pp. 878-883
2) Patel, Riherd. Focused assessment with sonography for trauma: methods, accuracy, and indications. Surg Clin N Am 91 (2011); 195-207.
4) Blaivas, Ml Lyon, M; Sandeep, D. Prospective comparison of supine chest radiography an bedside ultrasound for the diagnosis of traumatic pneumothorax. Academic Emergency Medicine. Vol 12, Issue 9, Sep 2005; 844-849
5) Schultz, J.M.; Trunkey, D.D. Blunt Cardiac Injury. Crit Care Clin. 2004; 20(1):57-70
6) Fedaker, et al. Fatal traumatic heart wounds: Review of 160 autopsy cases. Isr Med Assoc J. 2005;7 498-501
7) Mandavia D.P.; Hoffner R.J.; Mahaney K.; Henderson S.O.  Bedside echocardiography by Emergency Physicians.  Ann Emerg Med. 2001;38(4):377