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"No So FAST"

Avi Roy Shapira trauma-list@trauma.org
Mon, 7 Apr 2003 08:52:39 +0300 (IDT)


Caesar, 

I accept your line of thinking, if you look at the study as an attempt to
push the envelope, and see if we can use FAST for more than it was
designed to do.  

However, in that case, the paper should read

	"Although FAST was designed as replacement for DPL, we wanted to
find if it could also replace CT in blunt trauma ....  Conclusion: no we
can't"  

But this is not how it was phrased or stated.  The paper actually gives
the impression that in NORMAL practice, FAST is considered a CT
replacement, and that the authors are trying to save the world from this
bad practice.

Avi 


 



On Thu, 3 Apr 2003, caesar ursic wrote:

> > FAST was not designed to replace CT or diagnostic
> > laparotomy. So why
> > complain when it does not do what it can't?  
> > 
> > Why would one expect that a one day course on doing
> > FAST will teach one a
> > technique that radiologists take a life time to
> > master?  Does a 2 day ATLS
> > course make a trauma expert? 
> > 
> > FAST is relieble for one thing and only one thing:
> > detecting significant
> > amount of blood/fluid in one or more of its three
> > cardinal points.
> > 
> > In these days of selective operative management, the
> > information FAST
> > yields (YES/NO to the blood question) is useful only
> > in the unstable
> > trauma patient.  
> > 
> > We all knew (or shoud have known) that before we
> > read the paper.
> > 
> > Avi 
> 
> Reducto ad absurdum:  "And the internet was never
> originally designed to replace the writing and posting
> of letters.  So why complain to Microsoft when your
> e-mail gets jumbled by a bug in their program?"  
> 
> The truths you espouse are not so self-evident to
> everyone.  The fact is, FAST has and is being looked
> at as a possible replacement for CT in blunt abdominal
> trauma by many individuals and centers.  This paper,
> and others, suggest that such a substitution is  not a
> wise one.  Criticizing the paper becasue it "asks the
> wrong question" appears to be misdirected.  The push
> to use technology (like FAST) in new, different, and
> potentially advantageous ways is a fundamental
> principle of progress in any field.  If we sit back
> and accept that FAST has reached its potential and
> never question new applications of existing
> technology, then progress is likely to grind to a
> halt.  And you wouldn't want THAT, now would you?
> 
> C.M. Ursic, M.D.
> UCSF-East Bay
> Oakland, California
> 
> 
> 
> 
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==========================================================================
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel
 
email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390