EM Quick Hits 48 – FAST in Pediatric Trauma, Multiple Myeloma, Drowning, AKA, Global EM

Topics in this EM Quick Hits podcast Heather Cary on the use and misuse of abdominal FAST in pediatric trauma (0:38) Hans Rosenberg and Arleigh McCurdy on the diagnosis and management of Multiple Myeloma in the Emergency Department (7:57) David Jerome on wilderness practice tips for managing the drowning patient (13:50) Brit Long and Michael Gottlieb on the diagnosis and management of Alcohol-Induced Ketoacidosis (31:58) Navpreet Sahsi on his journey to becoming a humanitarian and global EM doctor (38:13) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Alex Chan, Heather Cary, Hans Rosenberg, Arleigh McCurday, David Jerome, Brit Long, Navpreet Sahsi and Michael Gottlieb, edited by Anton Helman Cite this podcast as: Helman, A. Cary, H. Rosenberg, H. McCurdy, A. Jerome, D. Long, B. Gottlieb, M. Sahsi, N. EM Quick Hits 48 - FAST in Pediatric Trauma, Multiple Myeloma, Drowning, AKA, Global EM. Emergency Medicine Cases. April, 2023. https://emergencymedicinecases.com/em-quick-hits-april-2023/. Accessed December 6, 2024. Abdominal FAST exam does not improve outcomes and may complicate pediatric traumas * Despite abdominal FAST exams being commonly used in North America, literature suggests that FAST has low sensitivity (estimated to be 28% for EM physicians) and high false-negative rate without improving clinical outcomes * Only two-thirds of children with intraabdominal injuries would have positive FAST with free fluid * As the majority of intraabdominal injuries are managed conservatively, providers should avoid using positive FAST as the deciding factor to order abdominal CT. They should instead use the clinical picture of the patient and indications such as: * Significant abdominal wall trauma * Seatbelt or handlebar sign * GCS < 14 in blunt abdominal wall trauma * Abdominal tenderness and/or distention * Persistent hypovolemia * PR/NG blood * Gross hematuria * Suspected pelvic fracture Episode 95 Pediatric Trauma Expand to view reference list * Trauma. 27/11/2018. https://starship.org.nz/guidelines/trauma/ * Andrew Tagg . Thinking FAST, and slow, Don't Forget the Bubbles, 2018. Available at: https://doi.org/10.31440/DFTB.17324 * Liang, Tian MD∗,†; Roseman, Eric MD∗,†; Gao, Melanie BA∗,†; Sinert, Richard DO∗,†. The Utility of the Focused Assessment With Sonography in Trauma Examination in Pediatric Blunt Abdominal Trauma: A Systematic Review and Meta-Analysis. Pediatric Emergency Care 37(2):p 108-118, February 2021. | DOI: 10.1097/PEC.0000000000001755 * National Cancer institute. Radiation Risks and Pediatric Computed Tomography (CT): A Guide for Health Care Providers. Reviewed September 4, 2018. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/radiation/pediatric-ct-scans * Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis. CJEM.