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"No So FAST"tony joseph firstname.lastname@example.org
Tue, 08 Apr 2003 07:54:50 +1000
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At 09:11 AM 7/04/03 +0300, you wrote: > Avi I agree. It depends on what you want to achieve. The Radiology ultrasonographers usually have much more powerful machines than available in the Trauma room and they are also trained to do a comprehensive exam. This may also apply to some individuals in the TRauma room and other non-radiology areas (but only a minority I suspect). The learning curse I also agree differs between individuals. We concentrate on identifying clinically significant blood in the abdo (ie requiring laparotomy) and our accuracy for that appears to be close to 100% if you exclude clinically insignificant blood found on CT. That takes at least 25 -30 exams with a minimum of 5 positives. It has also taken each of our individuals attaining credentially about 2 1/2 years to achieve the numbers regards Tony 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 >> > >> > >> > >> > >> > >> > >> > >> > >> >> >> >> __________________________________________________ >> >> Do you Yahoo!? >> >> Yahoo! Platinum - Watch CBS' NCAA March Madness, live on your desktop! >> >> http://platinum.yahoo.com >> >> >> >> -- >> >> trauma-list : TRAUMA.ORG >> >> To change your settings or unsubscribe visit: >> >> http://www.trauma.org/traumalist.html >> >> >> > >> >========================================================================== >> >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:email@example.com Fax:972-7-6403260 voice:972-7-6403390 >> > >> > >> > >> > >> >-- >> >trauma-list : TRAUMA.ORG >> >To change your settings or unsubscribe visit: >> >http://www.trauma.org/traumalist.html >> > >> > >> >> >> -- >> trauma-list : TRAUMA.ORG >> To change your settings or unsubscribe visit: >> http://www.trauma.org/traumalist.html >> > >========================================================================== >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:firstname.lastname@example.org Fax:972-7-6403260 voice:972-7-6403390 > > > > >-- >trauma-list : TRAUMA.ORG >To change your settings or unsubscribe visit: >http://www.trauma.org/traumalist.html > >