Survey of Hemodynamic Management (Monitoring) of Multiple Trauma Patients by Sonography in the Emergency Department

Background and Aim: The optimal monitoring of multiple trauma patients remains as a challenge. There are various invasive and non-invasive methods for monitoring hemodynamic status that affect the clinical outcome of multiple trauma patients. The present study compares eFAST (Extended Focused Assessment with Sonography in Trauma) with clinical (such as pressure and pulse) and paraclinical data (such as VBG, lactate and hemoglobin) to assess the response to treatment or worsening of the status of the patient with multiple traumas in the emergency department. The study also sought to assess whether ultrasound can provide more accurate and faster data regarding response to treatment or worsening of the status of a patient with multiple traumas.
Methods: The present study is a comparative study of diagnostic methods in multiple trauma patients over 14 years of age (male/female) who referred to the Emergency Department of hospitals from January 2018 and who have undergone an ultrasound evaluation. Demographic and clinical data was collected from all patients. Subsequently, these patients were monitored by ultrasound evaluation of the heart, IVC and lungs. For all patients, clinical findings such as pressure and pulse, and paraclinical methods such as VBG, lactate and hemoglobin were also recorded. Finally, ultrasound findings were compared with clinical and paraclinical findings using appropriate statistical methods.
Results: The mean age of 310 patients with multiple trauma due to traffic accidents was 36±11.5 years, and 67.7% (210) were male. The mean of IVC, EF, BE, hematocrit, hemoglobin, lactate, systolic and diastolic blood pressure, respiratory rate, heart rate, blood pH, blood PCO2, and HCO3 were significantly correlated with the deterioration of the patient according to eFAST (P <0.05). There was a significant relationship between mean IVC with different hemodynamic variables in patients with worsening eFAST. In this study, the development of eFAST from one space (initial eFAST) to other spaces (eFAST 6 hours later) or lack of fluid in the initial eFAST, and then fluid recording in one or more spaces at eFAST 6 hours later, was considered to be a deterioration in the patient's condition. In this condition, 80 patients with multiple trauma were registered.
Conclusion: The significance of positive (abnormal) eFAST association with different hemodynamic variables for assessing the response to treatment or deterioration of patient's condition, indicates that the hemodynamic monitoring of multiple trauma patients is reliable by ultrasonography in the emergency department. Therefore, eFAST and repeated eFAST can be used as a preliminary diagnostic tool in multiple trauma patients, in order to take the necessary therapeutic measures, and to avoid wasting time and increasing the cost to the patient, exposure to radiation and side effects of intensive action.