¨Banderas rojas¨ en el ultrasonido en la cama de casos quirúrgicos
Red flags in bedside ultrasonography for surgical cases.
Unlüer EE, Karagöz A.
Interv Med Appl Sci. 2013 Jun;5(2):85-8. doi: 10.1556/IMAS.5.2013.2.6. Epub 2013 Jul 4.
Abstract
Bedside ultrasonography is highly accurate in evaluating hypotension, even if performed by nonradiologist. Here we report three cases presenting with hypotension to the trauma room. In the first case, limited bedside ultrasonography demonstrated dilatation of the inferior vena cava and loss of respiratory variation in diameter. In further evaluation, dilated aortic root, massive pericardial effusion, collapse of right heart chambers, and a dissection flap at the anterior wall of base of ascending aorta were detected. With these findings, the patient was sent to the operation room with a diagnosis of DeBakey type 2 aortic dissection in approximately 15 min. In the second case, bedside ultrasonography demonstrated absence of pleural movements and comet tail artifacts on the right lung region of the patient. Together with deterioration of the vital signs, the patient was diagnosed as right-sided pneumothorax and underwent the tube thoracostomy. In the third case, bedside ultrasonography revealed the presence of free fluid in Morrison's pouch and splenorenal space in a hypotensive patient with a blunt abdominal trauma. He was consulted with general surgery department and was sent to the operation room without further diagnostic evaluation. In these cases, we emphasized the key role of bedsideultrasonography in hypotensive patients.
KEYWORDS: bedside ultrasonography, free fluid in the abdomen, hypotension, pericardial effusion, pneumothorax
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831800/pdf/IMAS-05-085.pdf
Estudio clínico controlado, randomizado de ¨punto de cuidado¨, de ultrasonografía en trauma en el servicio de urgencias: Primera evaluación del programa sobre la evaluación sonográfica
Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergencydepartment: the first sonography outcomes assessment program trial.
Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA.
Ann Emerg Med. 2006 Sep;48(3):227-35. Epub 2006 Mar 24.
Abstract
STUDY OBJECTIVE: Annually, 38 million people are evaluated for trauma, the leading cause of death in persons younger than 45 years. The primary objective is to assess whether using a protocol inclusive of point-of-care, limited ultrasonography (PLUS), compared to usual care (control), among patients presenting to the emergency department (ED) with suspected torso trauma decreased time to operative care. METHODS: The study was a randomized controlled clinical trial conducted during a 6-month period at 2 Level I trauma centers. The intervention was PLUS conducted by verified clinician sonographers. The primary outcome measure was time from ED arrival to transfer to operative care; secondary outcomes included computed tomography (CT) use, length of stay, complications, and charges. Regression models controlled for confounders and analyzed physician-to-physician variability. All analyses were conducted on an intention-to-treat basis. Results are presented as mean, first-quartile, median, and third-quartile, with multiplicative change and 95% confidence intervals (CIs), or percentage with odds ratio and 95% CIs. RESULTS: Four hundred forty-four patients with suspected torso trauma were eligible; 136 patients lacked consent, and attending physicians refused enrollment of 46 patients. Two hundred sixty-two patients were enrolled: 135 PLUS patients and 127 controls. There were no important differences between groups. Time to operative care was 64% (48, 76) less for PLUS compared to control patients. PLUS patients underwent fewer CTs (odds ratio 0.16) (0.07, 0.32), spent 27% (1, 46) fewer days in hospital, and had fewer complications (odds ratio 0.16) (0.07, 0.32), and charges were 35% (19, 48) less compared to control. CONCLUSION: A PLUS-inclusive protocol significantly decreased time to operative care in patients with suspected torso trauma, with improved resource use and lower charges
http://calgaryem.com/files/FAST.pdf
Ecografía FAST en la evaluación de pacientes traumatizados
FELIPE Catán G, A. DIVA Vilao M, Cristián Astudilo D.
REV. MED. CLIN. CONDES - 2011; 22(5) 633-639]
RESUMEN
El manejo inicial de los pacientes politraumatizados es uno de los mayores desafíos de la práctica clínica, ya que se requiere tomar decisiones muy rápidas basadas principalmente en criterios clínicos. La ecografía FAST ha demostrado ser útil parala detección de sangrado en el tórax y el abdomen, ademásde permitir detectar taponamiento cardiaco en paciente con trauma torácico penetrante y sospechar la presencia de neumotórax. Esto la ha transformado en una herramienta valiosapara la toma de decisiones terapéuticas en pacientes traumáticos,así como para la selección de pacientes en situaciones de catástrofes.
Palabras clave: FAST, ecografía, trauma.
http://www.clinicalascondes.cl/Dev_CLC/media/Imagenes/PDF%20revista%20m%C3%A9dica/2011/5%20sept/ecografia-fast-13.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Red flags in bedside ultrasonography for surgical cases.
Unlüer EE, Karagöz A.
Interv Med Appl Sci. 2013 Jun;5(2):85-8. doi: 10.1556/IMAS.5.2013.2.6. Epub 2013 Jul 4.
Abstract
Bedside ultrasonography is highly accurate in evaluating hypotension, even if performed by nonradiologist. Here we report three cases presenting with hypotension to the trauma room. In the first case, limited bedside ultrasonography demonstrated dilatation of the inferior vena cava and loss of respiratory variation in diameter. In further evaluation, dilated aortic root, massive pericardial effusion, collapse of right heart chambers, and a dissection flap at the anterior wall of base of ascending aorta were detected. With these findings, the patient was sent to the operation room with a diagnosis of DeBakey type 2 aortic dissection in approximately 15 min. In the second case, bedside ultrasonography demonstrated absence of pleural movements and comet tail artifacts on the right lung region of the patient. Together with deterioration of the vital signs, the patient was diagnosed as right-sided pneumothorax and underwent the tube thoracostomy. In the third case, bedside ultrasonography revealed the presence of free fluid in Morrison's pouch and splenorenal space in a hypotensive patient with a blunt abdominal trauma. He was consulted with general surgery department and was sent to the operation room without further diagnostic evaluation. In these cases, we emphasized the key role of bedsideultrasonography in hypotensive patients.
KEYWORDS: bedside ultrasonography, free fluid in the abdomen, hypotension, pericardial effusion, pneumothorax
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831800/pdf/IMAS-05-085.pdf
Estudio clínico controlado, randomizado de ¨punto de cuidado¨, de ultrasonografía en trauma en el servicio de urgencias: Primera evaluación del programa sobre la evaluación sonográfica
Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergencydepartment: the first sonography outcomes assessment program trial.
Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA.
Ann Emerg Med. 2006 Sep;48(3):227-35. Epub 2006 Mar 24.
Abstract
STUDY OBJECTIVE: Annually, 38 million people are evaluated for trauma, the leading cause of death in persons younger than 45 years. The primary objective is to assess whether using a protocol inclusive of point-of-care, limited ultrasonography (PLUS), compared to usual care (control), among patients presenting to the emergency department (ED) with suspected torso trauma decreased time to operative care. METHODS: The study was a randomized controlled clinical trial conducted during a 6-month period at 2 Level I trauma centers. The intervention was PLUS conducted by verified clinician sonographers. The primary outcome measure was time from ED arrival to transfer to operative care; secondary outcomes included computed tomography (CT) use, length of stay, complications, and charges. Regression models controlled for confounders and analyzed physician-to-physician variability. All analyses were conducted on an intention-to-treat basis. Results are presented as mean, first-quartile, median, and third-quartile, with multiplicative change and 95% confidence intervals (CIs), or percentage with odds ratio and 95% CIs. RESULTS: Four hundred forty-four patients with suspected torso trauma were eligible; 136 patients lacked consent, and attending physicians refused enrollment of 46 patients. Two hundred sixty-two patients were enrolled: 135 PLUS patients and 127 controls. There were no important differences between groups. Time to operative care was 64% (48, 76) less for PLUS compared to control patients. PLUS patients underwent fewer CTs (odds ratio 0.16) (0.07, 0.32), spent 27% (1, 46) fewer days in hospital, and had fewer complications (odds ratio 0.16) (0.07, 0.32), and charges were 35% (19, 48) less compared to control. CONCLUSION: A PLUS-inclusive protocol significantly decreased time to operative care in patients with suspected torso trauma, with improved resource use and lower charges
http://calgaryem.com/files/FAST.pdf
Ecografía FAST en la evaluación de pacientes traumatizados
FELIPE Catán G, A. DIVA Vilao M, Cristián Astudilo D.
REV. MED. CLIN. CONDES - 2011; 22(5) 633-639]
RESUMEN
El manejo inicial de los pacientes politraumatizados es uno de los mayores desafíos de la práctica clínica, ya que se requiere tomar decisiones muy rápidas basadas principalmente en criterios clínicos. La ecografía FAST ha demostrado ser útil parala detección de sangrado en el tórax y el abdomen, ademásde permitir detectar taponamiento cardiaco en paciente con trauma torácico penetrante y sospechar la presencia de neumotórax. Esto la ha transformado en una herramienta valiosapara la toma de decisiones terapéuticas en pacientes traumáticos,así como para la selección de pacientes en situaciones de catástrofes.
Palabras clave: FAST, ecografía, trauma.
http://www.clinicalascondes.cl/Dev_CLC/media/Imagenes/PDF%20revista%20m%C3%A9dica/2011/5%20sept/ecografia-fast-13.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
