CASE-BASED APPLICATIONS OF THORACIC FAST (TFAST)

摘要

The clinical utility of TFAST and its use for the rapid diagnosis of pleural and pericardial effusion, and pneumothorax (and the lung point concept) in trauma, triage (non-trauma) and tracking (monitoring) cases in the emergent and critical care settings will be reviewed (Lisciandro et al., JVECC 2008; Lisciandro, JVECC 2011; Boysen and Lisciandro, VCNA 2013; McMurray et al., JVECC 2014). The T~3 designation encompasses these 3 patient subsets and avoids the onslaught of confusing acronyms in human medicine in which similar abbreviated formats are given different acronyms when applied to different subsets of human patients. Thus, TFAST~3 becomes a universal term that has exact clarity in the 5-acoustic windows used by the veterinary TFAST~3 sonographer (Lisciandro, JVECC 2011; Boysen and Lisciandro, VCNA 2013).The TFAST~3 ultrasound format has greater potential to positively guide clinical course and improve patient outcome by detecting conditions and complications otherwise occult based on traditional means of physical examination, laboratory and thoracic radiographic findings. For example, the TFAST~3 Diaphragmatico-Hepatic (DH) View, should always be used as a window into the pleural and pericardial spaces (Lisciandro, JVECC 2015); and the TFAST~3 DH View complements the TFAST~3 Pericardial (PCS) Site Views. By applying TFAST~3 with this mindset, the misdiagnosis of fluid-filled heart chambers for pleural or pericardial effusion is less likely to occur; and thereby, avoid the potential for catastrophic mistakes such as performing centesis on a heart chamber (Lisciandro, JVECC 2015). Carrying the example further regarding the diagnosis of pericardial effusion: 1) ultrasound is the gold standard for the diagnosis or pericardial effusion, 2) both physical examination and thoracic radiography have poor and unreliable sensitivity, and 3) many cases are inappropriately treated because pericardial effusion is not suspected and the diagnosis is missed.Finally, TFAST~3 findings are made more clinically relevant for the clinician, client, and referring veterinarian, by using standardized ultrasound format (TFAST~3), and standardized goal-directed templates for medical records (see below) (Lisciandro etal., JVECC 2008; Lisciandro, JVECC 2011; Boysen and Lisciandro, VCNA 2013).