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Tue, 08 Apr 2003 07:54:50 +1000

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 
>> >  
>> > 
>> >
>> >
>> >
>> >
>> > 
>> >
>> >> 
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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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>> 
>> 
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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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