Vet360 Vet360 Vol 05 Issue 04 - Page 12

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 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.