December 2016 | Issue 27
A positive F.A.S.T

Kiang Wen Wei - bio pic.jpg

 

 

 

By Kiang Wen Wei, Class of 2018

 

Ultrasound was first used medically in the late 1940s, and since then, its effectiveness in diagnosis and guidance of therapeutic procedures have improved by leaps and bounds. Physicians in all medical fields have used ultrasound to great effect, and it has evolved into a key bedside imaging modality.

LKCMedicine’s curriculum is unique in its emphasis on the learning of medical imaging starting from our first year of medical school. In fact, one of the first few laboratory practical sessions was a hands-on introduction to echocardiography i.e. heart ultrasound scanning. As we progressed through our pre-clinical years, we went on to use ultrasound (and other imaging modalities) to enhance our learning of other organ systems – the biliary, genitourinary and vascular systems feature most prominently in my memory.

I must admit that at the time, I was slightly cynical about how useful it would be to have such early exposure to ultrasound. It was no doubt a fun and interesting experience – a fancy way of learning 3D anatomy, but I could not yet appreciate its usefulness for actual medical practice, as I did not fully appreciate how it could help to detect the abnormal.

Year 3 was a whole new experience as we were fully immersed in the busyness of hospital life for the very first time. It was during this year that I slowly began to appreciate the diagnostic and therapeutic utility of ultrasound, as we saw it being used extensively in all sorts of patients. Having been exposed to the technology in our pre-clinical years helped me pick up clinical ultrasound skills much more easily. Being able to “read” the ultrasound was also a great help – anatomical models or even plastinated organs looked vastly different from live specimens viewed through ultrasound.

However, it really was in Year 4 that ultrasound acquired a new dimension for me: my fellow Emergency Department (ED) students and I were given our first opportunity to perform ultrasound scans on real trauma patients under the supervision of the attending ED doctor. And it was during a consultation with one of these patients that I began to see the fruits of our School’s labour in teaching us ultrasound.

A young man was brought to the ED after a road traffic accident. He was the pillion rider on a motorcycle that had rear-ended a car and was flung a short distance before being sandwiched between his friend and the motorcycle. He was relatively stable, complaining of right shoulder pain – there was an obvious clavicular fracture – which was his primary concern. As he had also complained of pain in his right lower chest, my classmate, Joseph, and I performed a Focused Assessment with Sonography in Trauma (FAST) scan on him. Performed at the bedside, ultrasound is used to search for free fluid in the patient’s abdomen (blood being the most alarming) through various views – the essence of FAST. This is an important tool in the assessment of trauma as bleeding into the capacious abdominal cavity can potentially lead to life-threating haemorrhage.

With the ultrasound probe on the patient’s right abdomen, I was surprised to see that my probe revealed some free fluid in the Morrison’s pouch (Fig. 1), a potential space between the liver and right kidney. The attending doctor confirmed that it was indeed free fluid that I found and the patient was sent to the resuscitation area with activation of the trauma team. A subsequent CT scan confirmed the diagnosis of a liver contusion that responded to conservative management. The patient was discharged a few days later.

A positive FAST - scan with arrow.jpg
Figure 1. Ultrasound of the abdomen, showing a small amount of free fluid represented by a black stripe indicated by the arrow

While the knowledge that ultrasound is a useful diagnostic tool had always been head-knowledge for me, it was through this experience that I was better able to appreciate how much of an impact it really had on patient management. It was also not lost on me that previous opportunities to practice on simulated/ volunteer patients through Years 1 to 4 had certainly helped us pick up the technique more easily. I believe that our early exposure and familiarity with the technology meant that supervising physicians more readily offered us the opportunity to perform such scans as the FAST scan on patients.

Many of the doctors whom I have had the opportunity to meet in the clinical years have bemoaned the fact that ultrasound was, and still is, barely taught in medical schools both locally and internationally. I am rather thankful that we, as LKCMedicine students, have systematically learned this very simple and useful, but often not adequately taught, bedside imaging modality. It is my hope that as we graduate and join the medical workforce, we will carry these invaluable experiences to better manage our patients.