This month JC will close out our lecture and SIM focus on trauma patient assessment and management with a few articles on diagnostic tools for your consideration. First, an article on oblique chest X-ray for the detection of pneumothorax. I have not heard of this approach and want to thank Dr. Taheer for the article suggestion. We take advanced imaging and US resources for granted and this may be a useful addition should you find yourself practicing in an austere environment. The FAST exam has become a mainstay in adult trauma patient assessments however, data on its use in the pediatric population is very limited and has not been broadly adopted. We will look at a PECARN group secondary analysis of one of their huge databases on the topic and will look forward to our ever-growing EVMS ultrasound guru’s insights on the topic. Finally, RCT’s in ultrasound research are not commonly encountered and we will look at a hot off the press RCT on US for shoulder dislocations. I, for one, have always argued that atraumatic dislocations do not warrant adding pre-reduction X-rays to the patient’s misery waiting for them. Is a quick PoCUS a more worthwhile approach?  Should make for some interesting discussion.  

 Matsumoto S, et al, Diagnostic accuracy of oblique chest radiograph for occult pneumothorax: comparison with ultrasonography. World J Emerg Surg. 2016 Jan 13

Menaker J, et al Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. J Trauma Acute Care Surg. 2014 Sep;77(3):427-32.

 Biancardi A. et al., Diagnostic accuracy of point-of-care ultrasound (PoCUS) for shoulder dislocations and reductions in the emergency department: a diagnostic randomised control trial (RCT). Emerg Med J. 2021 Sep 20