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apapun tanpa seizin Direktur LPUK-USG
PUSKI
The Focused Assessment with Sonography
for Trauma is a rapid, bedside, ultrasound
examination performed to identify intra-
peritoneal haemorrhage or pericardial
tamponade
FAST assessment is indicated
in trauma patients who give
a history of abdominal trauma,
are hypotensive, or are unable
to provide a reliable history
because of impaired
consciousness due to head
injury or drugs

Standard FAST assessment is carried out using a
curvilinear 2.5 or 3.5 MHz probe
Whether performed and interpreted by radiologists or
adequately trained
non-Radiologist clinicians, the FAST examination has a
sensitivity, specificity, and accuracy that compares favorably
with diagnostic peritoneal lavage and computerized
tomography (CT) of the abdomen for the detection of
hemoperitoneum
The advent of diagnostic peritoneal lavage
(DPL), and more recently, CT and Ultrasound
have made early diagnosis and conservative
management for less severe injuries standard
care
In a collected series of 4.941 patients, surgeons
performed the FAST examination with :
Sensitivity of 93.4 %
Specificity of 98.7%
Accuracy 0f 97.5
This finding compares favorable
with a collected series of 997
patients in which FAST was
performed by radiologist with :
Sensitivity 90.8 %
Specificity 99.2 %
Accuracy 97.8 %
Herceglija E & Dalagija F
(1)
Institute of Radiology, Clinical Center of Sarajevo University,
Bosnia Herzegovina

Pasiae M, Smajloviae
(2)
Center for Urgen Medicine, Clinical Center of Sarajevo
University, Bosnia Herzegovina
By comparating with operative findings can conclude that ultrasound is not only
a good screening method, and so it can be a definitive diagnosis method too and
ultrasound findings can be the basis for indicated surgically treatment
Sensitivity of ultrasound is 76% and specificity 93%
FAST (Focused Abdominal Sonography for Trauma) is an ultrasound
examination to detect the presence of hemoperitoneum, hemothorax, and
hemopericardium. The examination involves a minimum of four views including
:
1. The hepato-renal interface (Morisons pouch) and the right diaphragm
2. The spleno-renal interface and left diaphragm
3. The pouch of Douglas
4. Subxiphoid or intercostal views of the pericardium
FAST examines four areas
for free fluid :
Perihepatic & hepato-renal
space
Perisplenic
Pelvis
Pericardium
Ultrasonography
in Chest Diagnostic
Daniel Makes
Dept. Of Radiology Faculty Of Medicine
University Of Indonesia/ Cipto Mangunkusumo Hospital
Jakarta
Indications for
chest US examination
1. Identification of pleural effusions, and to provide guidance for thoracentesis
2. Differentiation pleural from parenchymal lesion
3. Diagnosis of sub. pulmonics VS sub. phrenic fluid or abscess
4. Differentiation of a chest wall from pleural fluid
5. Characterization of mediastinal masses
6. Diagnosis of pericardial effusion
7. Diagnosis of diaphragm abnormality
Echocardiography is often used
at the bedside to evaluate for cardiac injuries
Hemopericardium may cause cardiac tamponade and
may require emergent pericardial drainage

The plural space is superficial
and readily examined by US
either a direct or an abdominal
approach. A high frequency (5-
7.5 MHz) linear transducer
applied directly to the chest
provide a broad near field of
view that allows excellent
visualization of pleural space

As much as 400-500 ml
of blood is required to obliterate
the costophrenic angle
as seen on an upright
chest radiograph




Frequency of Injuries Encountered in Trauma Patients
Referred for Chest CT (Kuhlman JE, 1996)
Pneumothorax : 69% (44/64)
Cardiac Contusion : 9% ( 6/64)
Lung Contusion : 67% (43/64)
Scapula Fracture : 8% ( 5/64)
Rib Fracture : 66% (42/64)
Sternal Fracture : 5% ( 3/64)
Hemothorax : 28% (18/64)
Diaphragm Injury : 5% ( 3/64)
Flail Chest : 14% ( 9/64)
Vascular Injury : 2% ( 1/64)
T-Spine Fracture : 13% ( 8/64)
Bronchus Fracture : 2% ( 1/64)
Clavicle Fracture : 13% ( 8/64)
Sensitifitas : 100%
Spesifisitas : 100%
Akurasi : 100%
Lamanya Pemeriksaan USG : 6-10
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