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Indications:

- Equivocal physical

examination- Unexplained shock or

hypotension

- Altered sensorium(closed head injury,drugs, etc.)

- General anesthesia for

extra-

abdominalprocedures

- Cord injury

2

Contraindications :

Clear indication forexploratory

laparotomy

Relative

contraindications:

- Previous exploratory

laparotomy

- Pregnancy

- Obesity

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Focused Assessment with Sonography for

Trauma (FAST)

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FAST:Strengths

Rapid (~2 mins) Portable

Inexpensive

Technically simple, easy totrain (studies show

competence can be achievedafter ~30 studies)

Can be performed serially

Useful for guiding triagedecisions in trauma patients

Limitations

Does not typically identify source of

bleeding, or detect injuries that do notcause hemoperitoneum

Requires extensive training to assessparenchyma reliably

Limited in detecting

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Indications Blunt trauma

Hemodynamic stability

Normal or unreliable physical

examination Mechanism: Duodenal and

pancreatic trauma

Contraindications Clear indication for

exploratory laparotomy

Hemodynamic instability

Agitation

Allergy to contrast media5

Advantages

Adequate assessment of theretroperitoneum

Nonoperative management of solid

organ injuries Assessment of renal perfusion

Noninvasive

High specificity

Disadvantages Specialized personnel

Hardware

Duration: Helical versusconventional

Hollow viscus injuries

Cost

CT SCAN Hemodynamically stable patient The patient should be in a transportable condition Triple contrast CT is the preferred mode

IV +O

RAL + RECTAL

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CT FAST DPL

Accuracy 96% 95-99% 95%Sensitivity 97% 90-92% 100%

Specificity 95% 88-90% 85%

Drawback Stable pts

only

Cannot evaluate

retroperitoneum. Cannot

identify source of fluid.

0.5% miss intestinal

perforation; cannotdistinguish blood vs

bowel contents