Education  |   August 2018
Application of Focused Assessment Ultrasound in Trauma to Perioperative Medicine: A Tool to Quickly Diagnose Postoperative Hemorrhage
Author Notes
  • From the Departments of Anesthesiology (S.M.H., D.A.B., H.W.); and Surgery (N.J.), West Virginia University, Morgantown, West Virginia.
  • Charles D. Collard, M.D., served as Handling Editor for this article.
    Charles D. Collard, M.D., served as Handling Editor for this article.×
  • Address correspondence to Dr. Wang: hong.wang1@wvumedicine.org
Article Information
Education / Images in Anesthesiology / Coagulation and Transfusion / Radiological and Other Imaging / Trauma / Burn Care
Education   |   August 2018
Application of Focused Assessment Ultrasound in Trauma to Perioperative Medicine: A Tool to Quickly Diagnose Postoperative Hemorrhage
Anesthesiology 8 2018, Vol.129, 333. doi:10.1097/ALN.0000000000002170
Anesthesiology 8 2018, Vol.129, 333. doi:10.1097/ALN.0000000000002170
The focused assessment ultrasound in trauma exam is a well established screening and diagnostic tool in the setting of trauma but is not widely utilized perioperatively. The sonograms shown in the figure depict free fluid (asterisks) surrounding the spleen (LUQ = left upper quadrant) and at the hepatorenal interface (RUQ = right upper quadrant), which led to immediate surgical reexploration after a routine hemicolectomy. Approximately 2 l of hematoma was evacuated, which was due to unrecognized liver laceration.
One of the objectives of the focused assessment ultrasound in trauma exam is to assess free fluid in the pericardial, peritoneal, and pleural cavities.1  Focused assessment ultrasound in trauma examination windows include subxiphoid for pericardial fluid, right upper and left upper quadrant for pleural and intraabdominal free fluid and suprapubic for free pelvic fluid. Free fluid tends to collect in dependent areas. Trendelenburg, reverse Trendelenburg, right lateral, and left lateral decubitus positions can increase the sensitivity for detecting free fluid in the upper abdomen, pelvis, hepatorenal interface, and splenorenal interface, respectively. Currently, there is no standard free fluid scoring system. The hemoperitoneum score, comprised of the diameter of the largest fluid collection in centimeters plus one point for each positive focused assessment ultrasound in trauma view, may help predict the need for surgical exploration when the value is greater than 3.2  The decision of when and if to operate should also be based on the clinical scenario.
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