Beyond the FAST Protocol: An Integrative Review on the Clinical Utility and Impact of Advanced POCUS Applications in the Trauma Patient
Keywords:
Ultrasonography, Wounds and Trauma, Transesophageal Echocardiography, Nerve Block, Resuscitation, Optic NerveAbstract
Introduction: The FAST protocol is the gold standard for detecting hemorrhage in trauma, but its ability to assess the pathophysiological complexity of critically ill patients is limited. Advanced point-of-care ultrasound (POCUS), including transesophageal echocardiography (TEE), transcranial Doppler, and regional blocks, promises to improve diagnostic and therapeutic accuracy. This review synthesizes the current evidence on its utility beyond FAST.
Methods: An integrative review was conducted following the framework of Whittemore and Knafl. A literature search was conducted in PubMed, Scopus, and Scite.ai (2014–2024), focusing on adults with trauma. Studies on resuscitation transesophageal echocardiography (TEE), the VEXUS protocol, optic nerve sheath measurement (ONSD), and ultrasound-guided procedures were included.
Results: Transesophageal echocardiography (TEE) for resuscitation demonstrated superiority over transthoracic echocardiography, modifying clinical management in up to 66.7% of cases of traumatic cardiac arrest. The VEXUS protocol allowed for the identification of venous congestion associated with acute kidney injury, guiding safer fluid resuscitation. In neuromonitoring, the onset of systolic nerve stimulation (ONSD) showed a high correlation with invasive intracranial pressure. Ultrasound-guided fascial blocks significantly reduced opioid consumption and systemic complications in rib and hip fractures.
Conclusions: The integration of advanced point-of-care ultrasound (POCUS) transforms trauma assessment from anatomical detection to dynamic physiological monitoring. Its implementation improves diagnostic accuracy, optimizes resuscitation, and humanizes pain management, justifying its inclusion in modern advanced life support protocols.
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