Objectives

1. Identify the wide range of uses of ultrasound in trauma.

2. Understand the concept of “hemodynamic state” assessment.

3. Understand how echocardiography interpretation can guide clinical management.

4. Understand the basics of focused abdominal sonography in trauma (FAST) and other surface ultrasound diagnostic studies.

5. Understand how to get started using ultrasound.

SUMMARY

The use of ultrasound in trauma anesthesia is increasing rapidly, including transesophageal echocardiography, transthoracic echocardiography, and a multitude of surface ultrasound applications including the FAST scan, and assessment for pneumothorax, pleural effusion, and deep vein thrombosis. It is being used as a guide for a number of procedures including vascular access, nerve blocks, pleural drainage, and percutaneous tracheostomy. This chapter will focus on hemodynamic assessment with echocardiography, as well as surface ultrasound diagnostic skills, whereas ultrasound-guided procedures are considered further in Chapter 32.

HOW MANY WAYS CAN ULTRASOUND BE USED DURING TRAUMA ANESTHESIA?

The key to successful use of ultrasound during trauma anesthesia is to understand that it provides rapid diagnostic information to assist patient management. The FAST scan (focused abdominal sonography in trauma) is well established in the emergency department for the assessment of abdominal trauma. Although this is a useful test, it is a small part of ultrasound use that is available in trauma. Hemodynamic state evaluation is a process of categorizing the underlying hemodynamic conditions by using echocardiography as an adjunct to our conventional clinical monitors. This is the single most useful area of ultrasound application in trauma. Better diagnostic information will translate into improved management.