John R. Richards, M.D., F.A.A.E.M.

Dr. Richards is Professor, Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California.

Dr. Richards reports no commercial conflict of interest.

Albert Einstein College of Medicine, CCME staff and interMDnet staff have nothing to disclose.

Release Date: 11/16/2009
Termination Date: 11/16/2012

Estimated time to complete: 1 hour(s).

Albert Einstein College of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

• Discuss the current role of ultrasonography (FAST) in the triage of blunt trauma patients.
• Discuss the interpretation of abnormal findings on FAST and implications.
• Discuss the therapeutic approaches to managing patients with blunt abdominal injuries and their disposition.
• Discuss the diagnostic options in subgroups such as pregnant, obese, and pediatric patients.

Blunt abdominal trauma (BAT) remains a diagnostic challenge to emergency physicians. Despite advances in motor vehicle and occupational safety measures over the past three decades, BAT resulting in intra-abdominal injury (IAI) represents a substantial cause of mortality and morbidity in the United States and worldwide. In this Cyberounds^® review I will discuss the variety of diagnostic imaging options for these patients, trends in utilization of these modalities, and management and disposition of BAT patients presenting to the emergency department. Imaging studies available to emergency physicians include focused abdominal sonography for trauma (FAST), computed tomography (CT), magnetic resonance imaging (MRI) and angiography. The incorporation of FAST into widespread practice has made diagnostic peritoneal lavage (DPL) obsolete in the United States, although it is still mentioned in trauma algorithms and may still be utilized in other countries.(1) Subgroups such as pregnant, obese and pediatric patients pose additional risks and difficulties to the clinician and will be discussed as well.

Case One

A 64-year-old female is brought to your emergency department (ED) after having been struck by a car at five miles per hour. She is complaining of left lateral chest wall pain. Her abdomen is non-tender. A portable chest radiograph shows no hemo- or pneumothorax or rib fractures. Her vital signs and labs are normal. You decide to perform FAST just to be safe, and notice the spleen is difficult to visualize with the probe and appears irregular. The left kidney appears normal, and there is no free fluid in the spleno-renal interface. The remainder of the FAST is negative.

Q	A 64-year-old woman is struck by a car. FAST exam at the ED is normal. What is the next step?
	Discharge home with an incentive spirometer and narcotic analgesics. Admit to the hospital for observation, pain control and serial hematocrits. Obtain CT of abdomen and pelvis. Request a formal ultrasound as the sonographer’s skills are probably better than yours.
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