Radiography and focused assessment with ultrasonography for trauma (FAST) play an important role in triage, often directing next step management [11-17]. The role of FAST (or extended-FAST or chest abdominal-FAST in evaluating chest injury) is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT [18,19]. Ultrasound (US) may be able to diagnose certain thoracic and abdominal injuries, but it is an insufficient test to fully exclude injuries to these areas because it has a relatively lower specificity compared with CT [20]. FAST can help triage patients and direct initial bedside and surgical procedures. Hemopericardium, pneumothorax, and free intraperitoneal fluid discovered at FAST have significant implications on next steps in management of the patient. Some trauma systems also use prehospital FAST to expedite management upon arrival to the hospital [14,16]. CT Chest, Abdomen, and Pelvis With IV Contrast Traditionally and in most practices, patients with penetrating trauma demonstrating signs of hemodynamic instability would be operatively managed without CT imaging [24]. However, recently, some authors recommend whole-body CT while continuing resuscitation regardless of hemodynamic status [25,26]. Proponents of this approach suggest the information gathered during CT helps determine the optimal surgical approach and prevents delay of definitive management. The degree of hemodynamic instability and distance to the CT scanner should be accounted for when deciding upon use of CT in this clinical scenario. CT Chest, Abdomen, and Pelvis Without and With IV Contrast There is no relevant literature regarding the use of CT chest, abdomen, and pelvis without and with IV contrast for initial evaluation of patients with penetrating torso trauma with hypotension.
Penetrating Torso Trauma. Radiography and focused assessment with ultrasonography for trauma (FAST) play an important role in triage, often directing next step management [11-17]. The role of FAST (or extended-FAST or chest abdominal-FAST in evaluating chest injury) is primarily one of triage; a positive FAST and signs of hemodynamic instability may lead to immediate surgical intervention rather than CT [18,19]. Ultrasound (US) may be able to diagnose certain thoracic and abdominal injuries, but it is an insufficient test to fully exclude injuries to these areas because it has a relatively lower specificity compared with CT [20]. FAST can help triage patients and direct initial bedside and surgical procedures. Hemopericardium, pneumothorax, and free intraperitoneal fluid discovered at FAST have significant implications on next steps in management of the patient. Some trauma systems also use prehospital FAST to expedite management upon arrival to the hospital [14,16]. CT Chest, Abdomen, and Pelvis With IV Contrast Traditionally and in most practices, patients with penetrating trauma demonstrating signs of hemodynamic instability would be operatively managed without CT imaging [24]. However, recently, some authors recommend whole-body CT while continuing resuscitation regardless of hemodynamic status [25,26]. Proponents of this approach suggest the information gathered during CT helps determine the optimal surgical approach and prevents delay of definitive management. The degree of hemodynamic instability and distance to the CT scanner should be accounted for when deciding upon use of CT in this clinical scenario. CT Chest, Abdomen, and Pelvis Without and With IV Contrast There is no relevant literature regarding the use of CT chest, abdomen, and pelvis without and with IV contrast for initial evaluation of patients with penetrating torso trauma with hypotension.