Aim/Background: Focused Assessment with Sonography for Trauma (FAST) has evolved into a common point-of-care diagnostic investigation in UK Emergency Departments (ED). Its role in the management of blunt abdominal trauma is well recognised. The aim of this study was to determine if the FAST scan can play a role in the management of non-traumatic patients.
Method: A literature review was performed with the emphasis on the use of FAST scanning in the non-trauma setting.
Results: In the acutely ill, undifferentiated, septic or decompensated patient, a Focused Assessment for Free Fluid (FAFF) scan may be of benefit, as a goal-directed investigation, to search for free fluid as an indicator of underlying disease source. The presence of free fluid in the non traumatised peritoneum implies primary or secondary intra-abdominal pathology requiring urgent specialist review and management. A FAFF scan can also play a role in the management of patients with abdominal aortic aneurysm, ectopic pregnancy and some thoracic conditions.
Conclusion: There is mounting evidence to support the efficacy of using such focused ultrasound, with its 'rule-in' high specificity, for helping reduce the potential differential diagnoses, at an early stage, in critically ill patients. We advocate the use of the term FAFF and not FAST, when emergency ultrasound is applied to non-traumatic clinical cases. We advise its liberal use by accredited clinicians, as part of a structured approach to the assessment of the undifferentiated, unwell patient presenting to emergency departments - especially those in shock or critically ill.
Point-of-care ultrasound (PoCUS) is an examination often performed at the bedside that can assist in patient assessment and answer focused questions. It is increasingly used by a number of specialties to aid invasive procedures and for clinical evaluation, with the ultimate aim of improving patient management. Although there is a paucity of robust evidence supporting some applications, it is gaining popularity and has been termed the 'new stethoscope'. Good clinical governance arrangements, especially with regard to training and competency, are key to this modality developing further and safely.
Introduction Sonographer-led-discharge was proposed in a maternity unit to provide a holistic service, cut waiting times, ease staffing pressures and increase job satisfaction. This study explored sonographers’ experiences and perspectives of this new extended role and other areas of non-obstetric role extension. Understanding these will inform future practice and the success of the proposed obstetric sonographer-led-discharge and career structure. Methods A mixed methodology, cross-sectional study was performed, with a purposive, non-probability sample using an online data collection tool. The data were analysed using descriptive statistics and thematic analysis. Results In total, 93 sonographers participated in the study. Of these, 25% of sonographers currently practising obstetric ultrasound said they would not undertake the proposed obstetric sonographer-led-discharge role extension although 90% of the participants said role extension provides job satisfaction. Several themes emerged from the data, including job satisfaction, benefits to the hospital, improved patient pathway, time, personal factors, litigation and intra- and interprofessional resistance. A total of 54% of staff currently performing a role extension have experienced either inter- or intraprofessional conflict and only 48.5% said their workload was manageable. Conclusions The data collected suggested that, with training and support, the proposed obstetric sonographer-led-discharge role is an appropriate role extension for sonographers. These findings support the premise of the proposed sonographic career structure, although the inter- and intraprofessional resistance identified in the study could form a significant barrier if it is not appropriately considered and managed.
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