1. Case Rounds Pass the Pointer Megan Leo, MD

2. IntroductionIntroduction FAST (Focused Assessment with Sonography for Trauma) Indication: Evaluation of a patient with blunt or penetrating trauma to the chest or abdomen Objective: to detect free intraperitoneal, intrathoracic, and pericardial fluid in the setting of trauma

3. FASTFAST Four main areas are evaluated on the FAST exam for free fluid, plus thoracic cavity RUQ (Right pleural space, Morrison’s Pouch) LUQ (Left pleural space, Subphrenic and Splenorenal fossa) Suprapubic (Males rectovesicular pouch, Females pouch of douglas) Subxyphoid (Pericardium) eFAST - thoracic ultrasound (pleural effusion, pneumothorax)

4. OutlineOutline Review Where’s the Fluid? Case Rounds

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13. Where’s the Fluid?

22. Case Rounds

23. Case 1 16 y/o male presents after a high speed boda boda accident Blood pressure 65/palp, Heart Rate 130 skin cold, pale

24. Case 1

28. Case 1 Conclusion 16 y/o male presents hypotensive and tachycardic, showing signs of shock FAST exam + in ALL quadrants This patient died in the operating room Management = surgery

29. Case 2 25 y/o female presents with severe lower abdominal pain. Blood pressure 90/50, Heart Rate 99 HCG positive

30. Case 2

33. Case 2 Conclusion Positive FAST exam with free fluid in the RUQ, LUQ, and pelvis Presumed ectopic pregnancy Management = surgical

34. Case 3 55 y/o male presents with abdominal discomfort and increased abdominal size. He is also reports dark urine. Blood Pressure 110/70, Heart Rate 98

35. Case 3

36. Case 3 Conclusion 55 y/o male with end stage liver disease with cirrhosis and ascites Diagnostic paracentesis negative for infection Diagnosed with constipation and discharged home

37. Case 4 45 y/o male presents in cardiac arrest after being found down in the street His family brings him to your clinic and you immediately note he is pulseless and start CPR After 3 rounds of CPR you do an ultrasound of his heart

38. Case 4

39. Case 4 Conclusion You stop CPR and break the news to his family that he was not able to be revived

40. Case 5 15 y/o male comes into your clinic with difficulty breathing and left lateral chest wall pain after falling off his boda onto the edge of the cement curb Blood Pressure 110/70, Heart Rate 102 Appears in pain but good color, dry skin, no tachypnea

41. Case 5

43. Case 5 Conclusion No pneumothorax You confidently diagnose the boy with a rib contusion vs. small fracture and tell him to go home and rest

44. Thank You!!!