SURGERY
Article sponsored by Petcam ®
Does it work? Are you ready for ultrasound?
I can see you are questioning these statements with
the appropriate critical eye. Is this really better? Does
this improve my patient evaluation? The answer—yes!
In a prospective study of 100 dogs presenting for
motor vehicle trauma, a FAST examination was found
to have 96% sensitivity and 100% specificity for the
detection of free abdominal fluid. 4 Yes! If you are intimidated by technology and ultrasonography,
there are numerous courses available for practicing
veterinarians, not only as wet and dry labs at conferences but
as online courses such as fastvet.com and textbooks with
images and protocols. 5
Further studies were performed to determine the
likelihood of the traumatic haemoperitoneum patient
requiring a transfusion. 1 A fluid scoring system was
described for the AFAST3 procedure, with one point
given for haemorrhage at each of the four locations
described above. An abdominal fluid score (AFS) of 0
means there is no effusion at any of the sites. An AFS
of 4 means fluid was present at all four sites. Dogs
with traumatic haemoperitoneum with an AFS of 1 or
2 are considered major-injury, small-volume bleeders
and rarely become anaemic from the intra-abdominal
haemorrhage. Alternatively, dogs that had an AFS of 3
or 4 are considered to be major-injury, large-volume
bleeders and are more likely to become anaemic. In
this study, about 25% of patients with AFS scores 3
or 4 developed anaemia severe enough to require
transfusion therapy.
Serial
examinations
(tracking)
cannot
be
overemphasized. It's standard of care to repeat
FAST examinations four hours after admission in all
stable cases to make certain an AFS of 1 or 2 is not
developing into a 3 or 4. The take-home message: If
a patient has an AFS of 3 or 4, be prepared with blood
products, a blood donor or the possibility to transfer
the patient to another hospital to provide transfusion
therapy.
vet360
Issue 04 | SEPTEMBER 2018 | 12
Although ultrasonography is not 100% sensitive for intra-
abdominal haemorrhage, it is practically perfect for
recognizing intra-abdominal haemorrhage after trauma. An
ultrasonographic examination provides a rapid assessment,
which may not only improve patient care, but can be life-
saving.
References
1.
Lisciandro GR, Lagutchik MS, Mann KA, et al. Evaluation of an abdominal
fluid scoring system determined using abdominal focused assessment with
sonography for trauma in 101 dogs with motor vehicle trauma. J Vet Emerg
Crit Care 2009;19(5):426-437.
2.
Soderstrom CA, DuPriest RW Jr, Cowley RA. Pitfalls of peritoneal lavage in
blunt abdominal trauma. Surg Gynecol Obstet 1980;151(4):513-518.
3.
Shackford SR, Rogers FB, Osler TM, et al. Focused abdominal sonogram for
trauma: the learning curve of nonradiologist clinicians in detecting hemo-
peritoneum. J Trauma 1999;46(4):553-564.
4.
Boysen SR, Rozanski EA, Tidwell AS, et al. Evaluation of focused assess-
ment with sonography for trauma protocol to detect free abdominal fluid
in dogs involved in motor vehicle accidents. J Am Vet Med Assoc 2004;
225(8):1198-1204.
5.
Lisciandro GR. Focused ultrasound techniques for the small animal practi-
tioner. Hoboken, New Jersey: Wiley-Blackwell, 2014.