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Sat Oct 13 18:05:17 BST 2007

Roy,

FAST is indeed the standard of care.  And the reason it is fast is
'cause in experienced hands it can be done in under 2 minutes - and most
often under ONE!  Where does it fit?  You should be able to get it done
while one nurse is starting IV's (IF needed), the other is drawing
blood, the x-ray tech is positioning the plate, and the tech is starting
the foley.  Now, if you really want to light a fire, the FAST could be
done while the chest and pelvic films are being done, and all the rest
can be done IN THE OR!

There are your 5-8 minutes, with one or 2 to spare!  :-)

Just my 2 cents.

Ron

>>> Roy Danks <roydanks at hotmail.com> 10/13/2007 12:41 PM >>>
I never thought of that, but then again, at our center, the  ED
physicians are not involved with trauma patients (who meet activation
criteria) at all.  The rare, VERY RARE, exception would be if the
surgeon on-call were to take one to the OR and another hit the door
before the back up surgeon could arrive.  Happens, but not often.

If we go back to the original post, to re-direct, the question as one
of "how long should a seriously injured trauma patient be in the trauma
bay" (paraphased, but accurate).  

"serious" may be user-defined inasmuch as there are different levels,
of course.  Dr. Mattox has yet to present literature of evidence to
support his 3-8 min time frame.  I respect the hell out of the man for
his experience, candor and advancement of trauma surgery as we know it
today.  But he wants evidence that backs CTA for aortic injuries...I
want the same for time in the trauma bay.  Yes, there are ridiculously
long stays that are unwarranted and dangerous.  But there are short
stays that may be equally unwarranted and dangerous.

I submit this question to the list:  Is FAST considered a "standard of
care" diagnostic tool in the level I trauma center...whether interpreted
by the surgeon, surgery resident, radiologist/resident?  If you aren't
doing it, are you practicing beneath the standard?  And, back to Dr.
Mattox's response, how do you fit it into an 8 min trauma with ABC's,
chest tubes, etc?

RRD
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