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"No So FAST"

Avi Roy Shapira trauma-list@trauma.org
Mon, 7 Apr 2003 09:11:41 +0300 (IDT)


Tony, 

I have no disagreement whatsoever with what you say. We are not trying to
do a comperhansive study.  That we leave to the experts. We are just
trying to see blood in a few easily recognizable spots. 

There is much confusion here. Some of it is because in many parts of
Europe surgeons have been performing full fledged Ultrasound in the ER,
for both trauma and other surgical emergencies.  This is a full fledged
ultrasound, not FAST. The learning curve for surgeons is about 3 years,
during which they do several a day under supervision.  

In contrast, accuracy of FAST plateaus after 30-100, examinations. Clearly
we are talking about different tests.   It does not help that many of the
recent papers describe FAST, but title the paper Ultrasound. 

Avi



On Fri, 4 Apr 2003, tony joseph wrote:

> At 11:43 AM 4/3/03 +0300, you wrote:
> >On Mon, 31 Mar 2003, caesar ursic wrote:
> >
> Avi
> The fact remains that Ultrasond is not owned by Radiology.
> It is used responsibly by many disciplines including Obstetricians,
> Surgeons, Family Medicine Practitioners and Emergency Physicians.
> There is good evidence in the Emergency Medicine literature that it is
> reliable in the diagnosis of AAAs ( with an almost 100% accuracy) given the
> right clinical circumstances.
> The trauma use for haemoperitoneum and thus replacing DPL is also well
> validated in both the Surgical and Emergency Medicine literature.
> There are also many studies which validate its use in the diagnosis of
> Intrauterine pregnancy ( and exclusion of ectopic pregnancy) in 1st
> trimester bleeeding, DVT, biliary colic etc.
> These studies are all goal directed and do not intend to provide a
> comprehensive study as provided by the Radiology Dept ultrasonographer, but
> are intended to provide an answer to a single question eg is there a AAA etc?
> Those who want to use it like this should attend an introductory course and
> then spend time accrediting themselves to use the modality safely and
> accurately by a process which has been agreed at each institution.
> There is now recognition of this use by the Radiology organisations such as
> the American Institute of Ultrasound in Medicine ( AIUM) which now has
> formal dialogue with the American College of Emergency Physicians.
> A similiar process is now underway in Australia.
> regards
> Tony Joseph
> Sydney
> 
> 
> >> Sorry, I wasn't aware that you had already discussed
> >> this particular article.  I must have accidentally
> >> deleted that post.  But my point is that there is
> >> little data out there to support using FAST in the
> >> stable blunt trauma patient.  
> >
> >There is also very little data to support the use of FAST in diagnosing
> >gall stones, pregnancy, or alzheimer's disease.  
> >
> >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 
> >  
> > 
> >
> >
> >
> >
> > 
> >
> >> 
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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
> >
> >
> >
> >
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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