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Rolling a trauma patient onto the right side increases sensitivity of FAST examination
Author(s) -
Pigneri Danielle A.,
Behm Robert J.,
Granet Paul J.
Publication year - 2019
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.22797
Subject(s) - medicine , supine position , hemoperitoneum , abdomen , focused assessment with sonography for trauma , laparotomy , surgery , physical examination , prospective cohort study , prone position , radiology , nuclear medicine , abdominal trauma , blunt
Purpose Hemoperitoneum in the hypotensive trauma patient is an indication for emergent laparotomy. Focused assessment sonography in trauma (FAST) is a widely used tool for detecting hemoperitoneum. The usefulness of FAST is currently limited by low sensitivity. We hypothesize rolling patients onto their right side will pool small volumes of fluid into the right upper quadrant of the abdomen leading to increased sensitivity. Methods Peritoneal dialysis patients were recruited for voluntary participation in a small pilot prospective clinical trial. Each participant first underwent a supine FAST followed by a 30‐second roll onto the right side. Once back in the supine position, the FAST was repeated (FASTeR or FAST examination after right‐sided roll). About 50 mL aliquots of dialysate were sequentially infused into the abdomen and the imaging sequence repeated until a positive finding was obtained. Results Seven patients were consented for the study. One patient was found to have an equivocal examination secondary to renal cysts. All six remaining participants converted to a positive FASTeR at an intra‐abdominal fluid volume at which standard FAST was negative. Conclusions Rolling patients to the right side increased FAST sensitivity, converting false‐negative to true positives examinations. A larger study is needed to validate our preliminary data.