Parameter assessed in trauma | Imaging modalities | Required views | Pertinent findings and key values |
---|---|---|---|
(1) Hemothorax (Pleural cavity) ATLS [16] | Chest radiograph (Fig. 2a) | AP (Upright preferred) | Blunting of costophrenic angle or partial or complete opacification of the affected half of the thorax |
(2) Pelvic hemorrhage (a) AP compression fracture (15–20%) (b) Lateral compression fracture (60–70%) (c) Vertical shear fracture (5–15%) (d) Combined fracture mechanism Cullinane et al. [127] | Pelvic radiograph (Fig. 2b) | AP | (a) Pubic diastasis, disrupted pelvic ring (b) Internal rotation with injury risk to bladder and urethra (c) Vertical displacement of sacroiliac joint (d) Combined |
(3) Multisystem trauma | CT/ MDCT | 2D images of a “slice” of the body. Can be used to construct 3D images | Comprehensively detect trauma to the chest, abdominal, pelvic, and active bleeding |
(4) Hemopericardium (Pericardial tamponade) Klein et al. [46] | FAST (2D) M-mode Doppler | Subcostal/subxiphoid, parasternal long axis (PSLA), parasternal short axis (PSSA) and apical four chamber (A4C) | Tamponade criteria: Large fluid quantification, > 1 cm RA systolic collapse > 30% of the cardiac cycle RV diastolic collapse |
(5) Hemothorax (Pleural cavity) Brooks et al. [50] | FAST (2D) | RUQV: lower right thorax LUQV: lower left thorax (Angle the probe up above the diaphragm into chest cavity) | Anechoic area between the diaphragm and the parietal pleura within the costophrenic recess |
(6) Intraperitoneal free fluid (Abdomen) Holmes et al. [51] | FAST (2D) | RUQV (Hepatorenal view) LUQV (Perisplenic view) | Anechoic area (free fluid) between the liver and right kidney (Morisons’s pouch) Anechoic area surrounding the spleen and obscuring the interface between the spleen and left kidney |
(7) Intraperitoneal free fluid (Pelvic) Cullinane et al. [127] | FAST (2D) | Sagittal view Transverse view | Aided by fluid-filled bladder Anechoic area in the rectouterine space or pouch of Douglas (female) or rectovesical space (male) |
(8) Intravascular volume status: IVC size/collapsibility, for RAP | 2D (Fig. 4a, b) (Additional file 7: Video 7) | Visualization throughout the respiratory cycle | Size ≤ 2.1 cm; collapses > 50% during sniff = RAP 0–5 mm Hg Size > 2.1 cm; collapses > 50% during sniff = RAP 5–10 mm Hg Size > 2.1; collapses < 50% during sniff = 10- RAP 20 mm Hg |
(9) Intravascular volume status and cardiac function: LV and RV chamber size, areas, and volumes Lang et al. [56] | 2D Volume (Fig. 4c, d) (Additional file 8: Video 8) Function (Additional file 9: Video 9) | Parasternal long axis (PSLA), parasternal short axis (PSSA) and apical four chamber (A4C | Normal ranges: LVIDD 3.9–5.9 cm LVEDV 46–150 mL LVESV 14–61 mL LVEF > 51% RV FAC ≥ 35% |
(10) Cardiac stroke volume & function (LV): LVOT VTI Ristow et al. [58] | 2D; pulsed Doppler | Apical 5 chamber or 3 chamber views Optimal Doppler alignment Pulse wave Doppler at LVOT | Normal value: VTI ≥ 18 cm |
(11) RV function: TAPSE RV Tissue Doppler S’ Rudski et al. [54] | M-mode (TAPSE) Tissue Doppler (RV S ‘) | Optimal Apical four chamber view, alignment with TV annulus, M mode for TAPSE, Tissue Doppler for S’ | Normal value: TAPSE ≥ 16 mm RV S ‘ ≥ 10 cm/sec |