> Of course you need an abdominal probe! Yes, a modern CT gives great
> information, but it is still horribly slow. It may do the
> scan quicker,
> but there is still the process of waiting for the anesthetist
> to put the
> 7th line in, getting the patient on and off the scanner, and getting
> someone to look at it with you. And joy of joys, I don't have to ask
> permission to do a FAST scan!
I was thinking of the short paper in the EMJ last year from Germany where they did primary assessment; straight to CT; vertex to symphysis scan in under 5 minutes, then back to resus for further assessment while the radiologist looks at the scans which is probably the future for trauma resuscitation (although it is going to involve a lot of radiation). As our surgeons get more used to scanning before operating, you'll probably find that increasingly they want a CT to plan the operation before they put knife to skin (which makes a certain amount of sense) and also want a CT before they decide not to operate. If that happens, a negative FAST isn't going to alter your decision won't alter your decision to scan; a positive FAST in a haemodynamically not too bad patient won't alter your decision to scan; and in a compromised patient who won't tolerate a scan you'll probably still be going for a laparotomy regardless of the result of the FAST.
Any way round it, you'll still be doing a lot more cardiac than abdominal scans so at a choice between a 25 mm curved array that you can use for cardiac and is adequate for FAST or a longer curved array that is better for abdomens but you can't use for hearts I'd go for the former. You could go for both, but it adds to the cost (wide range of costs, but in general a basic transducer starts at £7,000). Also the linear array is very useful to have and once you have too many transducers you've got the question of where you keep them all.
Matt Dunn
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