ECMO-/ECLS

Ultrasound can be very useful for a rapid evaluation in the initial
resuscitation, and in cases where the child in unstable. There has been an
increase in the use of ultrasound in the trauma bay in the form of FAST
(Focused Assessment with Sonography in Trauma) exams. The goal of the
FAST scan is to identify fluid in four specific places: the pericardium, the pelvis,
the pouch of Douglas, and the left upper quadrant. The FAST scan can be
performed by surgeons or emergency medicine physicians in an expeditious
fashion within the trauma bay. The FAST scan cannot identify the source of the
fluid found. It is not designed to evaluate the individual organs in the peritoneal
cavity and the retroperitoneum. In multiple studies, the traditional FAST exam
has been found to have a low sensitivity and specificity for the diagnosis of
injuries in children [3-8]. A recently published large series directly comparing
FAST exam in children to CT or laparotomy for the presence of free fluid
concluded that a positive FAST suggested hemoperitoneum and associated
abdominal injury, but a negative FAST adds little in decision making.^ [7] Since
the majority of pediatric solid organ injuries, even those with significant free
fluid (hemoperitoneum), can be managed non-operatively, experts argue that a
positive FAST exam may not be very helpful in directing clinical care in the
pediatric population. In a pracitical sense, pediatric trauma surgeons utilize the
FAST scan to evaluate pericardial fluid or to give a quick assessment of the
peritoneal cavity if a child has to have an emergent non-abdominal procedure
(e.g., evacuation of epidural hematoma).