In patients who are not rapidly transported to the operating suite or the CT scanner after the initial assessment, standard radiographic imaging includes lateral C-spine, chest, and pelvic radiographs. The chest x-ray and pelvic films image the three regions (left hemithorax, right hemithorax, and extraperitoneal pelvis) outside the true peritoneal cavity that can accommodate volumes of hemorrhage sufficient to produce gross hypotension. X-rays in penetrating trauma are dictated by bullet entry site and include a chest x-ray for patients with torso penetrating trauma and appropriate extremity films to rule out fractures in patients with penetrating extremity injuries.
Echocardiography has become a useful diagnostic tool for emergency medicine physicians and trauma surgeons.17 A focused abdominal sonographic examination for trauma (FAST) is a rapid diagnostic tool performed with a 3.5-MHz probe that assesses for fluid in (1) the pericardium, (2) the hepatorenal recess of Morrison (a common location for blood in patients with hemoperitoneum), (3) the pelvis around the bladder, and (4) the perisplenic region. Abdominal sonography in the trauma patient is rapidly supplanting diagnostic peritoneal lavage as the procedure of choice to detect hemoperitoneum in the unstable trauma patient for whom transport to the CT suite is unsafe.
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