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Dizzy Gillespie

John Birks "Dizzy" Gillespie (/ɡᵻˈlɛspi/; October 21, 1917 – January 6, 1993) was an American jazz trumpeter, bandleader, composer, and singer.

AllMusic's Scott Yanow wrote, "Dizzy Gillespie's contributions to jazz were huge. One of the greatest jazz trumpeters of all time (some would say the best), Gillespie was such a complex player that his contemporaries ended up copying Miles Davis and Fats Navarro instead, and it was not until Jon Faddis's emergence in the 1970s that Dizzy's style was successfully recreated [...] Arguably Gillespie is remembered, by both critics and fans alike, as one of the greatest jazz trumpeters of all time."

Gillespie was a trumpet virtuoso and improviser, building on the virtuoso style of Roy Eldridge but adding layers of harmonic complexity previously unheard in jazz. His beret and horn-rimmed spectacles, his scat singing, his bent horn, pouched cheeks and his light-hearted personality were essential in popularizing bebop.

In the 1940s Gillespie, with Charlie Parker, became a major figure in the development of bebop and modern jazz. He taught and influenced many other musicians, including trumpeters Miles Davis, Jon Faddis, Fats Navarro, Clifford Brown, Arturo Sandoval, Lee Morgan, Chuck Mangione, and balladeer Johnny Hartman.

Biography

Early life and career

Gillespie was born in Cheraw, South Carolina, the youngest of nine children of James and Lottie Gillespie. James was a local bandleader, so instruments were made available to the children. Gillespie started to play the piano at the age of four. Gillespie's father died when he was only ten years old. Gillespie taught himself how to play the trombone as well as the trumpet by the age of twelve. From the night he heard his idol, Roy Eldridge, play on the radio, he dreamed of becoming a jazz musician. He received a music scholarship to the Laurinburg Institute in North Carolina which he attended for two years before accompanying his family when they moved to Philadelphia.

Gillespie's first professional job was with the Frank Fairfax Orchestra in 1935, after which he joined the respective orchestras of Edgar Hayes and Teddy Hill, essentially replacing Roy Eldridge as first trumpet in 1937. Teddy Hill's band was where Gillespie made his first recording, "King Porter Stomp". In August 1937 while gigging with Hayes in Washington D.C., Gillespie met a young dancer named Lorraine Willis who worked a Baltimore–Philadelphia–New York City circuit which included the Apollo Theater. Willis was not immediately friendly but Gillespie was attracted anyway. The two finally married on May 9, 1940. They remained married until his death in 1993.

Gillespie stayed with Teddy Hill's band for a year, then left and free-lanced with numerous other bands. In 1939, Gillespie joined Cab Calloway's orchestra, with which he recorded one of his earliest compositions, the instrumental "Pickin' the Cabbage", in 1940. (Originally released on Paradiddle, a 78rpm backed with a co-composition with Cozy Cole, Calloway's drummer at the time, on the Vocalion label, No. 5467).

After a notorious altercation between the two men, Calloway fired Gillespie in late 1941. The incident is recounted by Gillespie, along with fellow Calloway band members Milt Hinton and Jonah Jones, in Jean Bach's 1997 film, The Spitball Story. Calloway did not approve of Gillespie's mischievous humor, nor of his adventuresome approach to soloing; according to Jones, Calloway referred to it as "Chinese music". Finally, their grudge for each other erupted over a thrown spitball. Calloway never thought highly of Dizzy, because he didn't view Dizzy as a good musician. Once during a rehearsal, a member of the band threw a spitball. Already in a foul mood, Calloway decided to blame this on Dizzy. In order to clear his name, Dizzy didn’t take the blame and the problem quickly escalated into a fist fight, then a knife fight. Calloway had minor cuts on the thigh and wrist. After the two men were separated, Calloway fired Dizzy. A few days later, Dizzy tried to apologize to Calloway, but he was dismissed.

During his time in Calloway's band, Gillespie started writing big band music for bandleaders like Woody Herman and Jimmy Dorsey. He then freelanced with a few bands – most notably Ella Fitzgerald's orchestra, composed of members of the late Chick Webb's band, in 1942.

Gillespie avoided serving in World War II. In his Selective Service interview, he told the local board, "in this stage of my life here in the United States whose foot has been in my ass?" He was thereafter classed as 4-F. In 1943, Gillespie joined the Earl Hines band. Composer Gunther Schuller said:

... In 1943 I heard the great Earl Hines band which had Bird in it and all those other great musicians. They were playing all the flatted fifth chords and all the modern harmonies and substitutions and Gillespie runs in the trumpet section work. Two years later I read that that was 'bop' and the beginning of modern jazz ... but the band never made recordings.

Gillespie said of the Hines band, "People talk about the Hines band being 'the incubator of bop' and the leading exponents of that music ended up in the Hines band. But people also have the erroneous impression that the music was new. It was not. The music evolved from what went before. It was the same basic music. The difference was in how you got from here to here to here ... naturally each age has got its own shit".

Then, Gillespie joined the big band of Hines' long-time collaborator Billy Eckstine, and it was as a member of Eckstine's band that he was reunited with Charlie Parker, a fellow member. In 1945, Gillespie left Eckstine's band because he wanted to play with a small combo. A "small combo" typically comprised no more than five musicians, playing the trumpet, saxophone, piano, bass and drums.

Rise of bebop

Bebop was known as the first modern jazz style. However, it was unpopular in the beginning and was not viewed as positively as swing music was. Bebop was seen as an outgrowth of swing, not a revolution. Swing introduced a diversity of new musicians in the bebop era like Charlie Parker, Thelonious Monk, Bud Powell, Kenny Clarke, Oscar Pettiford, and Gillespie. Through these musicians, a new vocabulary of musical phrases was created. With Parker, Gillespie jammed at famous jazz clubs like Minton's Playhouse and Monroe's Uptown House. Parker's system also held methods of adding chords to existing chord progressions and implying additional chords within the improvised lines.

Gillespie compositions like "Groovin' High", "Woody 'n' You" and "Salt Peanuts" sounded radically different, harmonically and rhythmically, from the swing music popular at the time. "A Night in Tunisia", written in 1942, while Gillespie was playing with Earl Hines' band, is noted for having a feature that is common in today's music, a non-walking bass line. The song also displays Afro-Cuban rhythms. One of their first small-group performances together was only issued in 2005: a concert in New York's Town Hall on June 22, 1945. Gillespie taught many of the young musicians on 52nd Street, including Miles Davis and Max Roach, about the new style of jazz. After a lengthy gig at Billy Berg's club in Los Angeles, which left most of the audience ambivalent or hostile towards the new music, the band broke up. Unlike Parker, who was content to play in small groups and be an occasional featured soloist in big bands, Gillespie aimed to lead a big band himself; his first, unsuccessful, attempt to do this was in 1945.

After his work with Parker, Gillespie led other small combos (including ones with Milt Jackson, John Coltrane, Lalo Schifrin, Ray Brown, Kenny Clarke, James Moody, J.J. Johnson, and Yusef Lateef) and finally put together his first successful big band. Gillespie and his band tried to popularize bop and make Gillespie a symbol of the new music. He also appeared frequently as a soloist with Norman Granz's Jazz at the Philharmonic. He also headlined the 1946 independently produced musical revue film Jivin' in Be-Bop.

In 1948 Gillespie was involved in a traffic accident when the bicycle he was riding was bumped by an automobile. He was slightly injured, and found that he could no longer hit the B-flat above high C. He won the case, but the jury awarded him only $1000, in view of his high earnings up to that point.

On January 6, 1953 Gillespie threw a party for his wife Lorraine at Snookie's in Manhattan, where his trumpet's bell got bent upward in an accident, but he liked the sound so much he had a special trumpet made with a 45 degree raised bell, becoming his trademark.

In 1956 Gillespie organized a band to go on a State Department tour of the Middle East which was extremely well received internationally and earned him the nickname "the Ambassador of Jazz". During this time, he also continued to lead a big band that performed throughout the United States and featured musicians including Pee Wee Moore and others. This band recorded a live album at the 1957 Newport jazz festival that featured Mary Lou Williams as a guest artist on piano.

Afro-Cuban music

In the late 1940s, Gillespie was also involved in the movement called Afro-Cuban music, bringing Afro-Latin American music and elements to greater prominence in jazz and even pop music, particularly salsa. Afro-Cuban jazz is based on traditional Afro-Cuban rhythms. Gillespie was introduced to Chano Pozo in 1947 by Mario Bauza, a Latin jazz trumpet player. Chano Pozo became Gillespie's conga drummer for his band. Gillespie also worked with Mario Bauza in New York jazz clubs on 52nd Street and several famous dance clubs such as Palladium and the Apollo Theater in Harlem. They played together in the Chick Webb band and Cab Calloway's band, where Gillespie and Bauza became lifelong friends. Gillespie helped develop and mature the Afro-Cuban jazz style.

Afro-Cuban jazz was considered bebop-oriented, and some musicians classified it as a modern style. Afro-Cuban jazz was successful because it never decreased in popularity and it always attracted people to dance to its unique rhythms. Gillespie's most famous contributions to Afro-Cuban music are the compositions "Manteca" and "Tin Tin Deo" (both co-written with Chano Pozo); he was responsible for commissioning George Russell's "Cubano Be, Cubano Bop", which featured the great but ill-fated Cuban conga player, Chano Pozo. In 1977, Gillespie discovered Arturo Sandoval while researching music during a tour of Cuba.

Later years

His biographer Alyn Shipton quotes Don Waterhouse approvingly that Gillespie in the fifties "had begun to mellow into an amalgam of his entire jazz experience to form the basis of new classicism". Another opinion is that, unlike his contemporary Miles Davis, Gillespie essentially remained true to the bebop style for the rest of his career.

In 1960, he was inducted into the Down Beat magazine's Jazz Hall of Fame.

During the 1964 United States presidential campaign the artist, with tongue in cheek, put himself forward as an independent write-in candidate. He promised that if he were elected, the White House would be renamed the Blues House, and he would have a cabinet composed of Duke Ellington (Secretary of State), Miles Davis (Director of the CIA), Max Roach (Secretary of Defense), Charles Mingus (Secretary of Peace), Ray Charles (Librarian of Congress), Louis Armstrong (Secretary of Agriculture), Mary Lou Williams (Ambassador to the Vatican), Thelonious Monk (Travelling Ambassador) and Malcolm X (Attorney General). He said his running mate would be Phyllis Diller. Campaign buttons had been manufactured years before by Gillespie's booking agency "for publicity, as a gag", but now proceeds from them went to benefit the Congress of Racial Equality, Southern Christian Leadership Conference and Martin Luther King, Jr.; in later years they became a collector's item. In 1971 Gillespie announced he would run again but withdrew before the election for reasons connected to the Bahá'í Faith.

Dizzy Gillespie, a Bahá'í since 1968, was one of the most famous adherents of the Bahá'í Faith. It brought him to see himself as one of a series of musical messengers, part of a succession of trumpeters somewhat analogous to the series of prophets who bring God's message in religion. The universalist emphasis of his religion prodded him to see himself more as a global citizen and humanitarian, expanding on his already-growing interest in his African heritage. His increasing spirituality brought out a generosity in him, and what author Nat Hentoff called an inner strength, discipline and "soul force". Gillespie's conversion was most affected by Bill Sears' bookThief in the Night. Gillespie spoke about the Bahá'í Faith frequently on his trips abroad. He is honored with weekly jazz sessions at the New York Bahá'í Center in the memorial auditorium.

Gillespie published his autobiography, To Be or Not to Bop, in 1979.

Gillespie was a vocal fixture in many of John Hubley and Faith Hubley's animated films, such as The Hole, The Hat, and Voyage to Next.

In the 1980s, Gillespie led the United Nation Orchestra. For three years Flora Purim toured with the Orchestra and she credits Gillespie with evolving her understanding of jazz after being in the field for over two decades. David Sánchez also toured with the group and was also greatly influenced by Gillespie. Both artists later were nominated for Grammy awards. Gillespie also had a guest appearance on The Cosby Show as well as Sesame Street and The Muppet Show.

In 1982, Gillespie had a cameo appearance on Stevie Wonder's hit "Do I Do". Gillespie's tone gradually faded in the last years in life, and his performances often focused more on his proteges such as Arturo Sandoval and Jon Faddis; his good-humoured comedic routines became more and more a part of his live act.

In 1988, Gillespie had worked with Canadian flautist and saxophonist Moe Koffman on their prestigious album Oo Pop a Da. He did fast scat vocals on the title track and a couple of the other tracks were played only on trumpet.

In 1989 Gillespie gave 300 performances in 27 countries, appeared in 100 U.S. cities in 31 states and the District of Columbia, headlined three television specials, performed with two symphonies, and recorded four albums. He was also crowned a traditional chief in Nigeria, received the Ordre des Arts et des Lettres; France's most prestigious cultural award. He was named Regent Professor by the University of California, and received his fourteenth honorary doctoral degree, this one from the Berklee College of Music. In addition, he was awarded the Grammy Lifetime Achievement Award the same year. The next year, at the Kennedy Center for the Performing Arts ceremonies celebrating the centennial of American jazz, Gillespie received the Kennedy Center Honors Award and the American Society of Composers, Authors, and Publishers Duke Ellington Award for 50 years of achievement as a composer, performer, and bandleader. In 1993 he received the Polar Music Prize in Sweden.

November 26, 1992 at Carnegie Hall in New York City, following the Second Bahá'í World Congress was Gillespie's 75th birthday concert and his offering to the celebration of the centenary of the passing of Bahá'u'lláh. Gillespie was to appear at Carnegie Hall for the 33rd time. The line-up included: Jon Faddis, Marvin "Doc" Holladay, James Moody, Paquito D'Rivera, and the Mike Longo Trio with Ben Brown on bass and Mickey Roker on drums. But Gillespie didn't make it because he was in bed suffering from cancer of the pancreas. "But the musicians played their real hearts out for him, no doubt suspecting that he would not play again. Each musician gave tribute to their friend, this great soul and innovator in the world of jazz." In 2002, Gillespie was posthumously inducted into the International Latin Music Hall of Fame for his contributions to Afro-Cuban music.

Gillespie also starred in a film called The Winter in Lisbon released in 2004. He has a star on the Hollywood Walk of Fame at 7057 Hollywood Boulevard in the Hollywood section of the City of Los Angeles. He is honored by the December 31, 2006 – A Jazz New Year's Eve: Freddy Cole & the Dizzy Gillespie All-Star Big Band at The John F. Kennedy Center for the Performing Arts.

Death and legacy

A longtime resident of Englewood, New Jersey he died of pancreatic cancer January 6, 1993, aged 75, and was buried in the Flushing Cemetery, Queens, New York City. Mike Longo delivered a eulogy at his funeral. He was also with Gillespie on the night he died, along with Jon Faddis and a select few others.

At the time of his death, Gillespie was survived by his widow, Lorraine Willis Gillespie (d. 2004); a daughter, jazz singer Jeanie Bryson; and a grandson, Radji Birks Bryson-Barrett. Gillespie had two funerals. One was a Bahá'í funeral at his request, at which his closest friends and colleagues attended. The second was at the Cathedral of Saint John the Divine in New York City open to the public.

As a tribute to him, DJ Qualls' character in the 2002 American teen comedy film The New Guy was named Dizzy Gillespie Harrison.

The Marvel Comics current Hawkeye comic written by Matt Fraction features Gillespie's music in a section of the editorials called the "Hawkguy Playlist".

Also, Dwight Morrow High School, the public high school of Englewood, New Jersey, renamed their auditorium the Dizzy Gillespie Auditorium, in memory of him.

In 2014, Gillespie was inducted into the New Jersey Hall of Fame.

Style

Gillespie has been described as the "Sound of Surprise". The Rough Guide to Jazz describes his musical style:

"The whole essence of a Gillespie solo was cliff-hanging suspense: the phrases and the angle of the approach were perpetually varied, breakneck runs were followed by pauses, by huge interval leaps, by long, immensely high notes, by slurs and smears and bluesy phrases; he always took listeners by surprise, always shocking them with a new thought. His lightning reflexes and superb ear meant his instrumental execution matched his thoughts in its power and speed. And he was concerned at all times with swing—even taking the most daring liberties with pulse or beat, his phrases never failed to swing. Gillespies’s magnificent sense of time and emotional intensity of his playing came from childhood roots. His parents were Methodists, but as a boy he used to sneak off every Sunday to the uninhibited Sanctified Church. He said later, ‘The Sanctified Church had deep significance for me musically. I first learned the significance of rhythm there and all about how music can transport people spiritually.'"

In Gillespie's obituary, Peter Watrous describes his performance style:

"In the naturally effervescent Mr. Gillespie, opposites existed. His playing—and he performed constantly until nearly the end of his life—was meteoric, full of virtuosic invention and deadly serious. But with his endlessly funny asides, his huge variety of facial expressions and his natural comic gifts, he was as much a pure entertainer as an accomplished artist."

Wynton Marsalis summed up Gillespie as a player and teacher:

"His playing showcases the importance of intelligence. His rhythmic sophistication was unequaled. He was a master of harmony—and fascinated with studying it. He took in all the music of his youth—from Roy Eldridge to Duke Ellington—and developed a unique style built on complex rhythm and harmony balanced by wit. Gillespie was so quick-minded, he could create an endless flow of ideas at unusually fast tempo. Nobody had ever even considered playing a trumpet that way, let alone had actually tried. All the musicians respected him because, in addition to outplaying everyone, he knew so much and was so generous with that knowledge..."

Bent trumpet

Gillespie's trademark trumpet featured a bell which bent upward at a 45-degree angle rather than pointing straight ahead as in the conventional design. According to Gillespie's autobiography, this was originally the result of accidental damage caused by the dancers Stump and Stumpy falling onto the instrument while it was on a trumpet stand on stage at Snookie's in Manhattan on January 6, 1953, during a birthday party for Gillespie's wife Lorraine. The constriction caused by the bending altered the tone of the instrument, and Gillespie liked the effect. He had the trumpet straightened out the next day, but he could not forget the tone. Gillespie sent a request to Martin to make him a "bent" trumpet from a sketch produced by Lorraine, and from that time forward played a trumpet with an upturned bell.

Gillespie's biographer Alyn Shipton writes that Gillespie probably got the idea for a bent trumpet when he saw a similar instrument in 1937 in Manchester, England, while on tour with the Teddy Hill Orchestra. According to this account (from British journalist Pat Brand) Gillespie was able to try out the horn and the experience led him, much later, to commission a similar horn for himself.

Whatever the origins of Gillespie's upswept trumpet, by June 1954 he was using a professionally manufactured horn of this design, and it was to become a visual trademark for him for the rest of his life. Such trumpets were made for him by Martin (from 1954), King Musical Instruments (from 1972) and Renold Schilke (from 1982, a gift from Jon Faddis). Gillespie favored mouthpieces made by Al Cass. In December 1986 Gillespie gave the National Museum of American History his 1972 King "Silver Flair" trumpet with a Cass mouthpiece. In April 1995, Gillespie's Martin trumpet was auctioned at Christie's in New York City, along with instruments used by other famous musicians such as Coleman Hawkins, Jimi Hendrix and Elvis Presley. An image of Gillespie's trumpet was selected for the cover of the auction program. The battered instrument was sold to Manhattan builder Jeffery Brown for $63,000, the proceeds benefiting jazz musicians suffering from cancer.

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ijcmcrjournal · 2 years

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Evaluating the Utility of Fast in Acute Blunt Abdominal Trauma in the Emergency Department: 20 Years On by Lateef F*

Abstract

Introduction: Blunt abdominal trauma (BAT) is a common presentation in the Emergency Department (ED) and associated with high mortality and morbidity. Given the time-sensitive nature, it is necessary to evaluate if FAST possesses adequate sensitivity and specificity to confidently rule out life-threatening injuries and guide the course of management. A positive FAST result would indicate intra-abdominal injury and prompt urgent surgical intervention, particularly in hypotensive patients. This review aims to examine relevant literature to evaluate the diagnostic utility and outcomes of FAST, and important external factors to be considered.

Methodology: Keyword search of PubMed and the Cochrane Library yielded 514 articles, from which 61 studies were chosen based on the inclusion and exclusion criteria.

Results: FAST demonstrates low to moderate sensitivity and Negative Predictive Value (NPV) and high specificity and Positive Predictive Value (PPV) in detection of hemoperitoneum and associated intra-abdominal injuries. Sensitivity for detecting peritoneal fluid is the highest. While superior to DPL, it has yet to surpass the diagnostic utility and accuracy of CT.

Conclusion: FAST is essential and should remain the primary preliminary radiological assessment of acute BAT. A positive FAST is highly predictive of intra-abdominal injury but a negative FAST cannot accurately rule out intra-abdominal injury. Negative FAST results should be succeeded by continued clinical observation, and serial FAST examinations or CT-scan should clinical signs not correlate. Current literature offers no evidence that FAST should replace CT as the diagnostic standard for BAT or a definitive ability to determine the necessity of immediate surgical management.

Keywords: Focused Assessment for Sonography; FAST; E-FAST; Ultrasonography; Point Of Care Ultrasound; Pocus; Blunt Abdominal Trauma; Laparotomy and CT

Introduction

Abdominal trauma is a common presentation in the ED and also one of the leading causes of death in young adults, under 45 years. It can be broadly classified into high or low energy injuries, and blunt or penetrating abdominal trauma. Blunt abdominal trauma (BAT), may be the result of road traffic accidents, physical assault or falls from height. Penetrating injuries are generally caused by firearms and stabbings. The focus of this review will be blunt abdominal trauma, as it is by far the more common presentation. A study was conducted by The Western Trauma Association Multi-Centre Trials of 392,315 blunt trauma patients at 12 major trauma centres. Majority of the injuries were caused by motor vehicle collisions (60%). 47% of the patients had documented hypotension and solid organ, small bowel, and large bowel injuries occurred in 38%, 35%, and 28% respectively. The most commonly associated injuries were spine fractures (44%) and pneumothorax/haemothorax (42%) [1].

Up to 50% of patients with severe abdominal trauma and/or multiple distracting injuries are reported to either have a normal initial abdominal exam, or are obtund and unable to provide a reliable index of suspicion. This affects both the physical and imaging examinations [2]. Diagnostic errors are responsible for approximately 10%–15% of preventable deaths in trauma centre audits. The sole reliance on clinical assessment as the main indication for surgery has led to negative laparotomy rates of as high as 40% [3]. A retrospective analysis found the incidence of short‐term complications caused by negative laparotomy to be 43% [4].

A quick, effective and efficient imaging approach is necessary to exclude life-threatening injuries. This modality would preferably need to have high sensitivity and specificity [5]. Prior to FAST, Diagnostic Peritoneal Lavage (DPL) was the standard initial diagnostic investigation. Although an invasive test, it could be done rapidly and was relatively safe with high sensitivity but had a significant false‐positive rate, which potentially exposed patients to the risks of an unnecessary laparotomy [6]. All patients who sustain blunt trauma to below the nipple line, are assumed to have intra-abdominal injuries until proven otherwise. Prompt reliable diagnosis and characterization of the abdominal injuries is essential to reduce risk of mortality and morbidity. Hemodynamic instability is a high-risk clinical sign and as such, both the diagnostic and interventional thresholds for these patients should be lowered. The three main types of blunt abdominal trauma injuries are solid organ injury, hollow viscos/mesenteric injury and vascular injury. The most commonly injured intra-abdominal organ is the spleen, followed by the liver and the genitourinary tract [7].

Immediate laparotomy should be done for patients with signs of peritoneal irritation, fresh blood on rectal exam, fresh blood aspirated from nasogastric tube, stab wounds with implement in-situ, gunshot wounds traversing the abdominal cavity, suspected intra-abdominal injury with hemodynamic instability, ultrasound evidence of active haemorrhage, and X-ray evidence of pneumoperitoneum or diaphragmatic rupture. In a retrospective cohort study of consecutive normotensive blunt trauma patients at 2 trauma centres, there was a strong association between a positive FAST and the need for therapeutic laparotomy. (Adjusted OR 44.6, 95% CI 1.77–1124). Thirty-seven percent of patients with a positive FAST required therapeutic laparotomy vs. 0.5% with a negative FAST [8]. Another study quoted lower figures, where only 25% of patients with intra-abdominal fluid required laparotomy [9].

Imaging modalities most often used to evaluate abdominal trauma in the ED are the Focused Assessment for Sonography for Trauma (FAST) and the Computed Tomography scan (CT-scan) which is the current reference diagnostic gold standard. The purpose of this study is to present a systematic review on the utility of the primary first line imaging modality FAST, in the acute assessment of blunt abdominal trauma.

Methodology

A systematic review of the literature was achieved using the electronic database PubMed and the Cochrane Library. Various query terms were tested to obtain enough data and to avoid unspecific information. Duration of search was from 1stMarch 2020 to 1stApril 2020. There was no limit on geography, age, type of study or date of article. Only original studies published in English were considered for this review. Keyword search yielded 514 articles, from which 61 studies were chosen based on the inclusion and exclusion criteria.

The keywords used in the search include: Focused Assessment for Sonography, FAST, E-FAST, Ultrasonography, Point of Care Ultrasound, PoCUS, Blunt abdominal trauma, Laparotomy and Computed tomography, CT

For studies to be included in this study, the inclusion criteria are as follows:

Acute presentation of blunt abdominal trauma at the ED

PoCUS/FAST or E-FAST examination done performed by radiologists, non‐radiologist clinicians, or ultrasound technicians

Definitive diagnosis verified by CT-scan or operative diagnosis.

Sufficient information on diagnostic test accuracy (i.e. sensitivity, specificity)

The studies were excluded if:

Insufficient information on diagnostic test accuracy

Case reports, case series

Unclear index or reference tests

Diagnostic case-control studies that compared patients with known case status to healthy controls. (This creates artificial populations and tends to overestimate sensitivity of the index test)

Patients with penetrating abdominal injuries

Results

Focused Assessment for Sonography for Trauma (FAST)

Ultrasound based trauma algorithms were only introduced formally into trauma literature in 1996.FAST is a limited abdominal ultrasound modality used in acute trauma as part of Advanced Trauma Life Support (ATLS)protocol to identify intra-abdominal fluid collections using a 3.5Hz sector transducer. FAST was established in 1999 after the FAST consensus conference and a subsequent study done at Massachusetts General Hospital in Boston, USA, showed the number of FAST scans increased from 15 % to approximately 34 % in the period 2002–2011, while the number of abdominal CT scans decreased from 35 % to 14 % in the same period [10]. In a prospective study on influence of FAST on trauma management, 194 patients underwent FAST. It was shown that FAST prevented an unnecessary laparotomy in 1 patient, CT in 23 patients, and DPL in 15 patients. There was an overall reduction in CT requests (from 47% to 34%) and DPL requests (from 9% to 1%) (p < 0.0001) [11].The goal of FAST is to detect hemoperitoneum in the right and left sub phrenic space, peri-splenic fossa, hepatorenal recess, suprapubic window (Pouch of Douglas or rectovesical pouch) and hemopericardium in the subxiphoid space. A positive FAST result would mean that there is free fluid in either of these abdominal compartments, which is a surrogate for active haemorrhage and in one study, has demonstrated a 65% sensitivity in detection of abdominal injuries requiring surgery [12].

E-FAST and Ex-FAST

E-FAST was established in 2004 and is now the diagnostic standard of ATLS, virtually replacing DPL. The E component refers to bilateral anterior thoracic sonography which searches for free air in the pleural cavity as evidence of an acute traumatic pneumothorax. It has been shown to have greater sensitivity and specificity than traditional chest radiography [13]. There is also some reference to Extended FAST or Ex-FAST. It is a combination of both physical examination and FAST. An abnormal examination constitutes signs of hemodynamic instability, abdominal bruising, tenderness, absence of bowl sounds, peritonism, seatbelt sign, lacerations etc. [14]. In a retrospective study of 354 children in the ED of which 14% (n=50) had intrabdominal injury (IAI), the use of Ex-FAST showed greater sensitivity (sensitivity of 88% (95% CI: 76‐96%) and Negative Predictive Value (NPV) 97.3% (95% CI: 94.5‐98.7%)) over either physical examination [OR, 15.2; 95% CI: 7.7 ‐ 31.7] or FAST [OR, 14.8; 95% CI: 7.5 ‐ 30.8] alone [15].

The execution time of E-FAST examination averaged 2.3 ± 2.9 min for chest US and ≤5 min for standard FAST [16]. FAST has been reported to be able to detect as little as 200ml of fluid in Morrison’s pouch and can completed in less than a minute in the hands of an experienced operator. This is many times faster than a CT-scan which on average takes approximately 30minutes and hence unsuitable for an unstable patient in an emergent setting. Moreover, it is easily repeatable, physicians can be easily trained, inexpensive, non-invasive and does not require contrast nor exposes the patient to ionizing radiation. Although these are insufficiently substantiated by sufficient evidence, other possible beneficial outcomes include shortening of the primary trauma assessment, more precise triaging, avoidance of unnecessary interventional procedures, and associated costs

The reliability and quality of images obtained from FAST is also greatly dependent on the training and experience of its operator. A comparison of the reproducibility of FAST results between Emergency Medicine Residents (EMRs) and Radiology Residents (RRs) showed sensitivities, specificities, PPV, NPV and accuracy of evaluating intra-peritoneal fluid to be very similar at 80%, 95%, 57%, 98% and 94% and 86%, 95%, 59%, 98% and 94%. This shows that EMRs are well-trained to use FAST and their results would be similar if not identical to an RR [17]. However, a comparism done in another study amongst US operators with low, moderate and extensive experience reported sensitivities of 45%, 87%, and 100% respectively in detecting <1L of peritoneal fluid [18].

A recent review article has quoted FAST sensitivities that range between 63 % and 99 % and specificities range from 90% to 100%. These results are similar for the detection of free intraperitoneal fluid, with sensitivities ranging from 69 % to 98 % and specificities of 94% to 100% [19]. Another study reviewing literature from various institutions around the world has reported lower thresholds of sensitivities ranging from 42.0%–91.7%, specificities 83%–100% and accuracies 9%–96% for the utility of E-FAST examinations. Its own prospective observational study examining the diagnostic accuracy of E-FAST done by emergency physicians compared to CT at the ED of a level 1 trauma centre found that out of 132 patients with blunt abdominal trauma, FAST sensitivities (only abdomen) was 42.9% (95% CI: 9.9%, 81.6%) and specificity was 98.4% (95% CI: 94.3%, 99.8%). The + LR of the FAST exam for abdominal free fluid as 26.8 (95% CI: 5.3, 135.2) and − LR was 0.58 (95% CI: 0.31, 1.1) [20]. This consistently high reported specificity of FAST was highlighted in a systemic review of 11 articles containing prospectively derived data with FAST results, patient disposition and final diagnoses. It showed that out of the 2,755 patients, 448 (16%) went to the OR. In total, there were 5 false-negatives derived from FAST; 3 involving inadequate scans and 2 of blunt trauma-induced small bowel perforations without hemoperitoneum [21]. The sensitivity of an examination is the “correct positive test rate” and measures the proportion of patients with an intraabdominal injury who have a positive test result. A high degree of sensitivity is not useful to rule in a diagnosis, but rather to rule out a particular condition. Similarly, high levels of specificity indicate that positive findings will detect the presence of a pathology. This suggests that when FAST is positive, there is high certainty of injury but when it is negative there’s a higher chance the injury was undetected. Hence, there is still large uncertainty in diagnostic confidence, with its wide sensitivity range and cannot confidently or safely exclude the presence of intra-abdominal injury.

FAST in Abdominal Trauma

In a meta-analysis [22] of emergency ultrasonography for BAT, a sensitivity range was observed as low as 28% and as high as 97%, specificities were close to 100%. A summary measure of 0.90 was calculated for the sensitivity-specificity pair closest to the desirable upper left corner of the ROC curve, which could be interpreted as 10% of abdominal injuries will be missed by FAST. Low sensitivities, coupled with low NPV, negative LRs and associated post-test probability, diminishes confidence in negative FAST findings. However, high specificities and LRs>10 would almost confirm intra-abdominal injury if positive and hence the need for surgical management.

In a retrospective study, 3181 blunt normotensive trauma patients presenting at a single level 1 trauma centre were evaluated with FAST and stratified into various groups of Injury Severity Scores (ISS). A one-time, four-view FAST examination in patients with ISS ≥ 25 had a lower sensitivity of 65 % than those with an ISS < 25 (80–86 %). More than 82 % of the FAST-missed injuries in patients with ≥ 25 ISS were solid organ injuries of the liver, spleen and kidneys [23]. An observational study of the diagnostic accuracy of FAST in 105 patients from King Fahad Military Medical Complex Dhahran, Saudi Arabia with blunt abdominal trauma demonstrated sensitivities of 76.1% (95% CI, 64.14- 85.69%), specificity 84.2% (95% CI, 68.75- 93.98%) and accuracy 79% (95% CI, 70.01- 86.38%. FAST could detect free fluid in 37 out of 39 patients with high grade sold intra-abdominal injuries. However, it could not detect small amount of fluid and nearly half of the negatives had low grade visceral injuries [24]. These studies highlight potential factors that may affect the results of the FAST examination, such as the presence of multiple other distracting injuries, higher likelihood for missed solid organ injuries and reduced sensitivity for fluid in patients with only low-grade injuries.The reason for this could be that hemoperitoneum is not always seen in liver or splenic injuries and hence it doesn’t matter if FAST has a high sensitivity for peritoneal fluid [12].

A systemic review evaluating the diagnostic accuracy of point‐of‐care sonography (POCS) for diagnosing thoracoabdominal injuries in patients with blunt trauma included 34 studies with a cumulative cohort of 8635 participants. For abdominal trauma, POCS had a sensitivity of 0.68 (95% CI 0.59 to 0.75) and a specificity of 0.95 (95% CI 0.92 to 0.97), with statistically significant lower values in children. To put this in perspective, it meant 73 false negatives and 29 false positives for every 1000 adult patients, assuming the observed median prevalence of thoracoabdominal trauma of 28% [25].

In paediatric BAT patients, the diagnostic accuracy of FAST has been reported to be lower compared to adults. A multi-institutional (n=14) analysis of level1 paediatric trauma centres yielded low sensitivities (28%) and high specificities (91%) for IAI consistent with paediatric literature but improved sensitivities (44%) and similar specificities (89%) for IAI requiring acute intervention. However, FAST missed 75% of liver injuries and 57% of spleen injuries and 56% of 27 patients whom required acute intervention for IAI had negative FAST. All the patients were normotensive and had abnormal abdominal examination [26]. However, in a separate observational prospective study comparing FAST evaluation of hypotensive and normotensive children with BAT, FAST showed a 100% sensitivity in detecting peritoneal fluid in hypotensive patients [27]. A prospective study was done on 160 hemodynamically stable paediatric trauma patients who had undergone both FAST and CT. Forty-four of the 160 patients had an intraabdominal injury on CT, 24 (55%) of which had normal screening sonography. Accuracy of sonography compared with CT was 76% with a negative predictive value 81% [28]. While the statistics of these three studies on the use of FAST in paediatric BAT patients do vary, sensitivities and specificities are both generally on the lower threshold of the adult range. They also show consistency of hypotension as a strong predictor of IAI and the poor ability of FAST to detect solid organ injuries.

FAST and Other Modalities

A prospective study [16] was done of 601 adult trauma patients at the ED who underwent a Chest Abdominal-Focused Assessment Sonography for Trauma (CA-FAST) exam prior to a thoracoabdominal CECT. Free fluid was detected in 116 patients with an overall accuracy of 91 % (95 % CI 85–93%). The following table illustrates the results of 4-view FAST and its individual views

FAST has different sensitivities for each abdominal cavity view, which translates to different diagnostic accuracies for the various types injuries previously mentioned in the methodology has well. In this study, FAST exhibits moderate to good sensitivity than previously quoted and with similar sensitive for the upper abdominal regions, followed by the pelvis and least able to detect fluid in the subxiphoid, pericardial space. It also shows good PPV, high specificity and NPV, consistent with previous studies [16].

This is supported by a 2-year review at a level1 trauma centre of 1027 patients who underwent FAST were stratified by operator skill level. It was shown that compared to patients with concordant FAST results, those with equivocal results had higher mortality (9.8 vs 3.7%, P = 0.02), decreased positive predictive value in the right upper quadrant (RUQ) (55 vs 79%, P = 0.02) and left upper quadrant (LUQ) (50 vs 83%, P < 0.01). However, unlike the previous study, this study observed worse outcomes has a result of the high rate of false negatives in the FAST examination.

However, some of these findings were obtained from only a single FAST scan (i.e. [23]), with the underlying assumption that fluid accumulates in the deepest parts of the abdomen. This can be influenced by anatomy, location of bleed, respiratory physiology, intra-abdominal adhesions etc. Thus, it would be prudent to consider the value of serial FAST scans, Contrast Enhanced Ultrasonography (CEUS), additional abdominal views and other imaging modalities such as CT with or without contrast media. A retrospective analysis [29] comparing the use of CTAP and Complete Ultrasonography of Trauma (CUST) in 19128 patients to screen for blunt abdominal trauma (BAT) from 2000 to 2011 in a Level 1 trauma centre was performed. It found that outcomes in CUST is equivalent to routine CTAP for BAT and leads to an average of 42% less radiation exposure and more than $591,000 savings per year.

The shortcomings of FAST can be bolstered by the application of CEUS. A recent meta-analysis [30] of 9 studies investigating the diagnostic accuracy of CEUS of abdominal trauma patients at the ED demonstrated that the CEUS had a sensitivity of 0.981 (95% CI: 0.868-0.950) and a false positive rate of 0.018 (95% CI: 0.010-0.032) for identifying parenchymal injuries, with an AUC of 0.984. These accuracies are similar to that of contrast-enhanced CT. Another study done on the application of CEUS in paediatric patients concluded CEUS proved to be an effective investigation in the hemodynamically stable child for identifying parenchymal injuries and for the characterization of focal liver lesions. It also showed comparable performance to CT and MRI with a specificity of 98% for identifying benign lesions and a negative predictive value of 100% [31]. However, the need for contrast in identifying intra-abdominal injury may not always be relevant in contributing diagnostic value. It can add confidence in cases of interpretation doubts or diagnostic difficulties, but some studies have shown CEUS to have similar sensitivities to baseline US [32].

Splenic injuries are the most common intra-abdominal injury followed the liver in the setting of acute blunt abdominal trauma. CEUS has been shown to be able to overcome the lower sensitive of FAST in detection of traumatic injuries with the reference standard as CT, to reach almost similar levels of accuracies. Evaluation of severity of splenic injuries is particularly important in the decision for surgical management as the spleen should be preserved if possible, due to the dual immunological and haematological functions [33]. However, a retrospective cohort study [34] at a level 1 trauma centre of 332 patients found that patients with spleen, liver, or abdominal vascular injuries were less likely to have false-negative FAST examination results (OR 0.3; 95% CI 0.1 to 0.5). Surprisingly, false-negative FAST results were not associated with increased mortality (OR 0.89; 95% CI 0.42 to 1.9) and these patients were fortunately also less likely to require therapeutic laparotomy. (OR 0.31; 95% CI 0.19 to 0.52).This at first glance may seem puzzling compared to previous studies; however, this is consistent with the generally high specificities of FAST and its lower sensitivities for solid organ injury and lower grade injuries which naturally may be less likely to require surgical intervention or carry a high mortality rate.

Computed Tomography and Abdominal Injuries

Computed Tomography is superior to FAST in evaluating solid organ, hollow vicus, mesenteric injuries and active haemorrhage. However, it has disadvantages such as radiation exposure, risk of contrast nephropathy or allergy, high cost, limited availability, requires more time and the potential need for sedation in paediatric patients. A level 1 trauma canter in the USA reported the radiation exposure of patients with a median ISS of 14 within the first 24 hours at a median of about 40 mSv. The lifelong risk of dying from a carcinoma is assumed to increase by about 0.1 % per 10 mSV. This risk also depends on gender, age and radiation location [19]. Although this is a minute amount, we can conclude that CT scans should be avoided when possible as it does expose the patient to a significant amount of radiation, enough cause a measurable increase in cancer risk.

A recent retrospective analysis evaluated the diagnostic performance of CT for detection of hollow vicus injury (HVI) in patients presenting with penetrating abdominal trauma at a level 1 Nordic trauma centre. Out of the 636 patients with penetrating abdominal trauma, 155 (85%) had a CT-scan on arrival, of which 41 (30%) subsequently underwent emergent surgery. Surgery revealed only 26 (63%) has HVI, showing that CT had 69.2% sensitivity and 90.5% specificity in detecting HVI [35].

Although FAST showed high accuracy for peritoneal fluid, it’s non-specific for solid organ injuries and prevalence of organ injury without accompanying free fluid can range from 5% to 37% [36]. It also lacks sensitivity for hollow viscos and mesenteric injuries, which not are only the most commonly missed but also associated with high morbidity and mortality and has a higher likelihood for requirement of surgical intervention than solid organ injuries. A retrospective study done on 32 patients showed that MDCT could diagnose bowel injury in all of the patients except one. The minor signs showed a higher sensitivity than the major signs [3]. This suggests a sensitivity for bowel injury much greater than FAST which was 12.5% amongst 4 patients and 37.4% in another study [36]. Other studies have also quoted high sensitivities (94%) and PPV (92%) for CT in detecting bowel injury [37]. A meta-analysis [38] of articles concerning the incidence and significance of free intra-abdominal fluid on CT scan of blunt trauma patients without solid organ injury concluded that isolated finding of free intra-abdominal fluid on CT scan in patients with blunt trauma and no solid organ injury does not warrant laparotomy. Instead, its aetiology should be evaluated and other CT signs of GI perforation should be searched for. Small bowel injury had the highest incidence of positive free fluid without evidence of solid injury, but the combination of both pneumoperitoneum and free fluid increased the sensitivity of detection of small bowel injury [3].

When compared with its predecessor DPL, it showed significant advantage in its pre-test probabilities with a positive LR of 10.83 (95% CI 6.45 ± 18.17) and a negative LR of 0.11 (95% C.I. 0.06 ± 0.21). When compared to CT, FAST still had a positive LR 11´42 (95% C.I. 8.01 ± 16.29)) in confirming presence of intra-abdominal injuries, but it was still below acceptable thresholds in safely excluding abdominal injuries (negative LR 0.21 (95% C.I. 0.16 ± 0.29)), which is essentially the gold for immediate trauma management. Hence FAST is unable to be the diagnostic standard for obtaining a definite diagnosis [22].

Whole body CT (WBCT) is the gold standard for trauma imaging, however it is usually only supported by highly specialised trauma centres with the appropriate infrastructure. A clinical review highlighted observational data that suggested WBCT was associated with decreased mortality and time required for trauma evaluation [39]. On the other hand, randomized controlled data from the REACT-2 trial [40] suggests no mortality benefit to this diagnostic tool. There is no clear evidence or sufficient data to prove that CT should be the first line imaging modality in acute blunt abdominal trauma. As we simply lack the resources and time to conduct CT for every patient, not to mention the higher costs and having to subject every patient to ionizing radiation, the decision for CT should remain on a case to case basis. Decision making should be based on a combination of history, physical examination, clinical signs and other imaging modalities i.e. FAST/X-ray. More studies (i.e. RCTs) will have to be done to assess its outcomes over FAST in the emergency setting of BAT and its utility in assessing need for surgical intervention.

A study [41] assessed CT scans of paediatric patients with abdominal trauma for presence, location, and severity of intraabdominal injury, and amount of peritoneal fluid. It was found that only 17% of the 1,486 children had peritoneal fluid demonstrated by CT but 80% had concomitant intraabdominal injury. This suggests that although presence of peritoneal fluid is a strong indicator of intra-abdominal injury, it can be present without, with solid organ injury being the most frequent (68%). Furthermore, it may also indicate that like FAST, CT may have reduced sensitivity in picking up intra-abdominal injuries without peritoneal fluid. CEUS may be applicable for the 37% of patients with intra-abdominal injuries picked up by CT but no peritoneal fluid was detected.

Discussion

In the emergency department today, E-FAST is still the diagnostic standard for ATLS in the event acute abdominal trauma. Its findings, combined with history taking, physical examination and other imaging modalities (i.e. chest/abdominal radiography) would then determine the need for a CT-scan or emergent surgical intervention (i.e. laparotomy). Training with learning objectives and the duration as well as supervision should be standardized with the help of existing scientific principles. FAST demonstrates low to moderate sensitivity and high specificity as a single examination. There have been no studies that examined the utility of serial FAST examination. This is dependent on several factors such as, the time elapsed since trauma, type and extent of injury, patient group (i.e. age, BMI), quality of ultrasound machine, and skills of the FAST examiner. It was also mentioned previously that FAST results are also made on the assumption that fluid tracks to the most gravity dependant parts of the abdomen, and can be influenced by anatomy, location of bleed, respiratory physiology, intra-abdominal adhesions etc. However, it was seen in many studies that many patients who tested negative on FAST did have intra-abdominal injuries subsequently detected on CT or intra-operatively.

To improve sensitivity, the three standard abdominal FAST views should be supplemented by six further sections: sub diaphragmatic, caudal liver margin, parabolic groove, between intestinal loops, retroperitoneal and right upper abdomen view for the detection of free air. The examination should also include visualisation of solid organs such as spleen, liver, and kidneys to assess for injury. Serial exams can also be done at 12hourly intervals to reduce the likelihood of false negatives and reconfirm earlier findings. The effectiveness of serial FAST examinations in patients of deteriorating clinical status was demonstrated in a study that showed a 50% decrease in false-negative rates by 50% and an 85% increase in sensitivity for free fluid detection. The sensitivity and NPV for injury detection increased to 71% and 97%, respectively [42]. These aforementioned strategies can be investigated further through the conducting of randomized controlled trials. Diagnostic errors owing to human error can also be reduced through a more systematic approach such a diagnostic checklist, or management of physician fatigue. Albanese et al. also believed that serial physical examinations are the gold standard for diagnosing GI perforation from blunt abdominal trauma [43].

FAST does offer greater insight than solely relying on clinical signs but it is unsuitable to obtain a diagnosis with sufficient certainty nor can a negative result safely exclude intra-abdominal injury? Possible reasons for poorer accuracy could be that it was in the early post-injury phase, where sufficient hemoperitoneum had not yet accumulated thus leading to false-negative results. FAST has also shown poor sensitivity to identify hollow viscos or solid organ injuries not associated with hemoperitoneum such as early bowel injury or pancreatic injury and limited utility in detecting retroperitoneal haemorrhage. Other potential sources of error include obesity and subcutaneous fat, body habitus and positioning, ascites due to pre-existing medical condition, pre-existing pericardial effusion, and the presence of intra-abdominal cysts or masses [44]. Patients with these characteristics should be evaluated with a subsequent CT-scan if hemodynamically stable.

A comparative study [45] evaluating the use of FAST was done on 706 patients with blunt abdominal trauma. 460 patients were managed with FAST and 246 without FAST. Respectively, both groups showed similar accuracies at 99.1% and 98.0% respectively, and frequency of laparotomies at 13.5% and 14.2%. FAST patients also had a lower mean diagnostic cost and lower mean time required for diagnostic work up. In the FAST group, the computed tomographic rate was 24%, whereas it was 91% in the no-FAST group. As previously established, it’s been shown in many studies that FAST greatly reduced the need for CT-scans, a recent review quoting rates as high as 50%. Although there are surprisingly no significant differences in mortality or laparotomy rates. These two studies show that FAST is cheaper, fast, decreases the length of hospital stay, duration to definitive treatment, and use of healthcare resources [6]. However, it does not actually improve accuracies nor change the management or treatment outcomes of BAT.

Nevertheless, it is shown that peritoneal fluid if present, is highly sensitive to intra-abdominal injury, specifically active haemorrhage which is an indication for emergent laparotomy. This can not only save crucial time in achieving haemostasis instead of waiting for the results of the CT-scan, but is more accurate than DPL which is invasive, or simply clinical signs alone. Moreover, E-FAST is far superior to chest X-ray in terms of detecting haemothorax and pneumothorax and is the only simple bedside method for detecting hemopericardium. Thus, the purpose of E-FAST is for rapid assessment of intra-abdominal that require immediate surgical intervention, especially if the patient is hypotensive, and/or to evaluate the need for a CT-scan. FAST should not replace the abdominal examination or history taking nor be the sole modality replacing CT, for evaluation of abdominal trauma, particularly in patients with abdominal pain, contusions or altered mental status as it’s been shown to intra-abdominal injury can be present even without peritoneal fluid. While CT should not replace FAST either as the 1st line imaging modalities in BAT, a high index of suspicion and low threshold is required. Also, FAST does reduce the frequency of need for CT-scans in the ED and hence the overall costs and radiation exposure to the patient, along with more efficient use of hospital resources. If a new diagnostic algorithm is faster and less expensive it must also be as safe and accurate as the conventional diagnostic algorithm before it can become the new standard of care. Given the current level of evidence we have today, we can conclude that CT should still remain the gold standard for definitive evaluation of blunt abdominal trauma and guide its subsequent management.

Although CT does have greater diagnostic accuracy compared to FAST and is still the gold standard for definitive abdominal trauma imaging, there are little studies done to evaluate the outcomes of patients who have had a CT-scan done without E-FAST. It is established that CT-scan does carry significantly greater number of risks compared to FAST, including requiring more time which the hypotensive patient may not be able to afford. CEUS FAST has showed higher accuracies than conventional FAST in detecting liver, spleen, or kidney injury and active bleeding, similar to that of CT in children and adults with BAT. However, larger randomized trials to evaluated diagnostic accuracy and outcomes will be required to further validate its clinical use as the standard of care [19]. Assuming that major blunt abdominal or multiple trauma is associated with 15% mortality and a CT‐based diagnostic work‐up is considered the current standard of care, 874, 3495, or 21,838 patients are needed per intervention group to demonstrate non‐inferiority of FAST to CT‐based algorithms with non‐inferiority margins of 5%, 2.5%, and 1%, power of 90%, and a type‐I error alpha of 5% [6].

However, studies have shown that despite steady improvement of sonographic resolution properties over the past 20 years, diagnostic precision has not significantly improved, which may suggest that ultrasonography in the emergent setting and the experienced gain may have already reached its limit [22]. Technological advances have allowed recent development of wireless probes [46] and devices capable of short- and long-distance image transmission to remote displays. As ultrasound technology continues to evolve, we expect to see further miniaturization, better image quality and even holography or wearable technology [47]. The FAST exam is easily learned and educational materials are abundant both online (images and video) and in print. As both FAST and E-FAST increase in popularity, implementation of robust educational programs will become increasingly important so that future generations of practitioners are able to acquire high quality sonographic images, interpret those images, and also make real-time clinical decisions based on that information. Trauma centres can look into optimizing infrastructure and trauma protocols to shorten the time required for CT-scan, which has been reported in some studies to be as quick as only a few minutes. It is also crucial to emphasize integration of various sources of information and not to rely solely on a single modality.

Conclusion

FAST is an essential tool for preliminary assessment of intra-abdominal injury, including BAT. A FAST result if positive, in highly confirmative of intra-abdominal injury, for which emergent surgical management is indicated. However, a negative FAST cannot with sufficient diagnostic confidence, rule out intra-abdominal injury. The results of FAST should be considered in conjunction with clinical signs and relevant patient information. Patients with a negative FAST result should continue to be observed clinically, evaluated with serial FAST examinations or CT-scan should intra-abdominal injury be suspected. Developing technologies in Ultrasonography yield promising improvements to the FAST examination but current literature offers no evidence that FAST should replace CT as the diagnostic standard for BAT or its ability to definitively determine the necessity of immediate surgical management.

For more information about Article : https://ijclinmedcasereports.com/

https://ijclinmedcasereports.com/ijcmcr-ra-id-00152/ https://ijclinmedcasereports.com/pdf/IJCMCR-RA-00152.pdf

#Focused Assessment for Sonography #FAST #E-FAST #Ultrasonography #Point Of Care Ultrasound #Pocus #Blunt Abdominal Trauma #Laparotomy and CT #Lateef F*#IJCMCR #clinical studies

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camplofi · 5 years

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BSOTS 171 - BUCKWILD: The Faith-Based Practice of Podcasting

Feedback: who doesn't want that? Please feel free to get in touch via email, Twitter, or leave a voice message on the Speakpipe page.

This is a delayed transmission, recorded in December of 2019 with finishing touches and edits done the following month. It's rather odd how I keep returning to this knowing the inevitable delays that will prevent the next episode from surfacing online sooner than I would like. The recording and editing of a show: those are the places I want to live all the time. Things like show notes and updating RSS feeds, however...that's another story. And then there's the "hey! look over here" aspect of it all, the marketing campaign that has to take place after you've created a thing, be it through social media blasts or other means. It's a strange game of faith that content creators play. In a day and an age where it seems like everyone wants to get in on podcasting, I find it rather presumptuous to think that someone would want to listen to mine (even though I know for a fact that some people have for years now).

Maybe I've been doing this for too long, but this is the thing that I turn to when the world (and particularly the work days) get to be too much. I don't do this for monetization's sake. I don't do this for sponsors. I still do this for the reasons that I did it back in 2005: as a creative outlet and for my own sanity. The need for a primal scream in my podcast feed every now and then was the whole reason why the "buckwild" episodes began in the first place. I was overdue for another one of these and considering that the world feels like it's on fire, perhaps these types of episodes ought to be released more frequently.

However you might have stumbled upon this, thank you for taking the time to listen. It's 2020, y'all. Here goes nothin'.

This episode's track list: 1. Cheese - The Return (CC license) 2. Jonny Sonic - Blue #3 3. Flying Lotus - Yellow Belly (feat. Tierra Whack) 4. Little Simz - Boss 5. Tenesha The Wordsmith - Dangerous Women 6. Tha Silent Partner - Covfefe's Groove (CC license) 7. Rodney P - The Next Chapter 8. Gawd Status - Messiah Hybrids 9. DJ Shadow - C.O.N.F.O.R.M. feat. Gift Of Gab, Lateef The Truth Speaker, Infamous Taz 10. Brother Ali - Red Light Zone 11. Vula Viel - Fire 12. Mikal Amin - We Keep It Movin'

BSOTS BONUS TRACK: Samurai Guru - Everyone Go Through It

ID drops courtesy of Kahlee, Mr. Ivory Snow, DarrenKeith, and EJ Flavors.

Background music includes the following: Anti-Pop Consortium - The Hands Behind The Piano Of Time Is God MUTE - Eeekin Days (CC license) BADLUCK - Vanity (instrumental) (CC license)

Other key info: Opinions While Black

Another BSOTS podcast episode for the people...

#BSOTS #podcasts #music #hip-hop #soul #funk #jazz #electronic

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bharatiyamedia-blog · 5 years

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Survivors of torture in Kashmir Half 2: 28 years later, Manzoor Ahmad Naikoo says he is been diminished to 'lower than zero'

http://tinyurl.com/y3x3wyrn Editor’s observe: In a first such report compiled over a span of 10 years, Srinagar-based rights physique Jammu and Kashmir Coalition of Civil Society (JKCCS) has documented accounts of 432 survivors of torture since 1989, when armed militancy took root within the Valley. Safwat Zargar met 4 of those survivors to doc their tales. That is half two of a four-part series. *** When militancy erupted in Kashmir in 1989, Palhallan city of North Kashmir’s Baramulla district turned one among its bastions with dozens of boys crossing the Line of Management for arms coaching. However Manzoor Ahmad Naikoo, 30, one of many flourishing shopkeepers in Palhallan, wasn’t amongst them. Naikoo, who got here from an impoverished background, opened a common grocery retailer in 1983. Over time, the store ensured monetary stability for his household. Nonetheless, all of that got here crashing down on 28 September, 1991. The report, launched on 20 Could, demanded a probe commissioned by the United Nations into the allegations of torture in Jammu and Kashmir. Picture courtesy: JKCCS Naikoo was picked up throughout a crackdown by the personnel of two Dogra Regiment stationed at Hyderbeigh space of Pattan. He, together with one other native Lateef Mir, was tortured inside a authorities college constructing after which at his Palhallan residence. In truth, mentions of Naikoo’s case in Jammu and Kashmir Coalition of Civil Society (JKCCS) report on torture crop up repeatedly. Naikoo is one among 432 victims of torture documented by Srinagar-based JKCCS over a ten-year span. The report, launched on 20 Could, was the primary of its variety, and demanded a probe commissioned by the United Nations into the allegations of torture within the conflict-riddled state. The report triggered a robust response from the Authorities of India, which determined it would not entertain any communications from the UN’s Geneva-based Human Rights Council (HRC) on the alleged human rights violations in Jammu and Kashmir. Among the many whole 432 instances research, 301 victims have been civilians, 119 militants, 5 have been ex-militants, whereas two belonged to the Jammu and Kashmir Police. Twenty-seven victims have been minors. In keeping with the JKCCS report, 49 victims died throughout or after torture. ‘Wished for demise’ “First, they stripped me and tied my palms behind my again,” Naikoo recalled. “After that, they put a material round my penis and set it on hearth. After I began screaming, they put my pajama inside my mouth to muffle my cries. It didn’t finish there: they introduced a bucket of water and thrust my head into it. Whereas my head was within the water, they inserted a stick into my rectum and moved it backwards and forwards until I began bleeding. I used to be in a lot ache that I needed for demise.” Naikoo was 30 on the time. Naikoo’s neighbour Lateef Mir, a authorities college trainer, was subjected to comparable torture. He did not survive. A day after the torture, Palhallan was put underneath strict curfew. “It took hours of negotiations with military personnel deployed on the street to permit me to go to a hospital. From my home, I used to be introduced in a hand-driven cart to the principle street with a view to be taken to the hospital,” Naikoo added. At Srinagar’s Shri Maharaja Hari Singh Hospital, Naikoo was subjected to an emergency colostomy. Whereas his accidents ultimately healed, a colostomy closure surgical procedure performed on Naikoo failed. “The surgical procedure failed to shut the opening close to my abdomen. Consequently, all of the waste materials produced in my physique stored leaking from it. I lived with this situation for 22 years as a result of docs suggested me in opposition to one other surgical procedure,” Naikoo defined. Dwelling with trauma However Naikoo’s situation didn’t affect his well being alone. Attributable to his situation, Naikoo prevented assembly individuals, attending features or travelling. For a few years, he didn’t go to the mosque. “My garments would all the time odor unhealthy as a result of urine and feces that may proceed to leak from the opening in my abdomen. I couldn’t management it. You’ll be able to’t think about what I went by way of,” Naikoo mentioned. Naikoo’s failing well being made him determined for an answer. However there was hardly one in sight. “I bought my cows, sheep, land and my spouse’s jewelry for my therapy, however I didn’t get higher,” he said. Naikoo’s ordeal coincided with a grueling authorized battle for justice. Seventeen years after his torture, that battle ultimately paid fruit, though little or no. In 2007, a neighborhood courtroom in Srinagar listening to a plea on behalf of Naikoo determined in his favour and ordered the state in addition to the Centre to pay him Rs 5 lakh as compensation. Whereas the courtroom proceedings confirmed Naikoo’s torture, it didn’t determine the perpetrators. Naikoo was left aghast. “I spent practically 5 occasions extra on my therapy. The compensation went to pay my lawyer’s charges and bills of eyewitnesses who needed to journey all the way in which to Srinagar,” Naikoo mentioned. In the meantime, in 2013, Naikoo lastly obtained a ray of hope when docs at a non-public hospital agreed to make one other try at colostomy closure. This time, the surgical procedure was profitable. However by then, Naikoo’s life had undergone some irreversible modifications. “I misplaced my enterprise. My daughter developed psychological well being issues and needed to bear psychiatric therapy. One in all my sons is a post-graduate and one other is a graduate, however as an alternative of doing respectable jobs, they’re now operating my store. The store is all we’ve got,” Naikoo rued. Now, 28 years later, Naikoo continues to be reeling from the results of that day. “I don’t exit in any respect. I sleep all through the day. My bones have grow to be weaker and I get drained shortly,” he mentioned. “I turned previous in my youth.” Ruined households Researchers at JKCCS, who led the primary ever examine on the widespread use of torture by state forces in Jammu and Kashmir, assert that it’s not the torture victims alone who bear the results of the aftermath. Whole households have been ruined. “In keeping with some knowledge on psychological well being, kids have developed psychological points on account of the torture of the elder family members,” Shazia Ahad, one of many researchers behind the report, advised Firstpost. “And there are financial losses as effectively in instances the place somebody is rendered unable to work as a result of torture.” Torture, researchers mentioned, additionally takes a toll on the psychological well being of victims. “Torture impacts individuals psychologically. We have now seen that victims of torture undergo from totally different psychological well being associated points resembling Put up Traumatic Stress Dysfunction, insomnia, and melancholy,” Shazia added. Naikoo doesn’t know if he’s affected by any of those as a result of he by no means consulted docs concerning his psychological well being. The 60-year-old displays on how torture modified his life, “Torture took me from being a member of the center class to lower than zero.” Your information to the newest cricket World Cup tales, evaluation, experiences, opinions, reside updates and scores on https://www.firstpost.com/firstcricket/series/icc-cricket-world-cup-2019.html. 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Ice Bath Benefits: How Cold Therapy Improves the Body and the Brain

New Post has been published on http://healingawerness.com/news/ice-bath-benefits-how-cold-therapy-improves-the-body-and-the-brain/

Ice Bath Benefits: How Cold Therapy Improves the Body and the Brain

You’ve probably seen me on Instagram enjoying surviving a soak in my cold plunge tub, and sharing about my trip to Finland where we literally jumped into a freezing river. I thought I should explain about ice bath benefits in a bit more detail, and the compelling reasons that convinced me to start working cold therapy into my health routine.

While it doesn’t seem natural that anyone would ever voluntarily chose to be extremely cold, at this point I’m hooked! Here’s why.

What Is Cold Therapy?

If music can change the brain and body, it shouldn’t be surprising that temperature can do the same thing.

Cold therapy is essentially the process of using cold temperatures for their health benefits. Many have used in many different ways since the 1700s to improve health and provide pain relief. Cold therapy can be as simple as using an ice pack on an injury, or as extreme as using a cryosauna (which I talk about here).

Ice bath therapy is something athletes have used for years to reduce pain and speed up recovery between games or workouts. But it seems the benefits of cold therapy go far beyond the locker room. This old tool for improved health is getting more buzz as new research comes out.

Ice Bath Benefits: Why I Traded in My Hot Tub

The general idea with ice bath therapy is that cooling the skin in water makes the body work harder to maintain internal temperatures. This increases blood flow to the entire body. The following are some more specific ice bath benefits.

Faster Recovery from Exercise and Injury

Athletes have known for a long time that cold therapy can help recovery from exercise. The idea is that cold reduces swelling and lactic acid that causes muscle soreness after a workout. It works by constricting blood vessels, according to a 2010 study.

Research seems to support what athletes have known for a while. One sports medicine study found that submerging in an ice bath after a strenuous run helped raise tissue oxygenation, which can help muscle repair.

Cold therapy also helps reduce pain from an injury. A 2014 meta-analysis showed that cold therapy can reduce pain, even after the body warms back up.

While pain reduction is a great thing, there are some reasons to use caution when icing for muscle recovery. Some researchers wonder if the inflammatory process could actually hinder muscle adaptation. According to this 2015 study, muscles learn to adapt to the kind of activity we’re doing based on the inflammatory response. If there is a lot of inflammation, the body learns that the muscles need to be able to do the level of activity that caused the inflammation. Essentially, that’s how we get stronger. Removing that inflammation may mean slower improvement.

Bottom Line: Cold therapy is fine for reducing pain occasionally, but should be used with caution for frequent muscle or injury recovery.

Immune System Boost

Because winter is often the time we get sick, it’s hard to believe that cold can improve the immune system, but it just might! A clinical trial in the Netherlands found that people who took cold showers called out of work 29% less often.

But fighting colds isn’t the only way cold therapy can help the immune system. Cold exposure increases leukocytes in the body which protect against disease.

Ice baths may even have an effect on cancer cells. Daily brief cold stress (like from a cold bath or shower) has been shown to increase the numbers and activity of cytotoxic T-cells and NK cells. These cells are the major players in preventing and attacking tumor cells.

Additionally, sudden ice-cold water immersion can increase blood-brain barrier permeability, which may help defend against some infections.

Improves Brain Function and Mood

Cold therapy may increase mental focus as well. This is likely due to the catecholamine release cold therapy provides. Exposure to cold activates the sympathetic nervous system and increases endorphins (feel-good neurotransmitters). It also increases the release of noradrenaline in the brain, which prepares the body for action and sharpens focus.

Cold therapy can also improve mood for similar reasons. Because of a large number of cold receptors in the skin, cold showers are expected to send electrical impulses to the brain, which could result in an antidepressant effect (like a milder, non-harmful electroshock therapy). In fact, it’s thought that cold therapy may have antipsychotic effects for the same reason. The electrical impulses from cold therapy may also “crowd out” the psychotic neurotransmissions.

Increased Energy, Metabolism, and Weight Loss

If you’ve ever jumped into cold water you know that the shock of the temperature can make you feel energized (and a bit giddy!). This is likely from the release of catecholamines (adrenaline and noradrenaline) and endorphins in reaction to the cold. It’s basically an adrenaline rush. Researchers even found that submerging in 57 degree water increased catecholamines by 530 percent!

Ice baths can also improve metabolism and accelerate weight loss. A study on the human metabolism found that cold exposure helps white fat act more like brown fat. Brown fat is the “good fat” that helps the body create heat (newborns have lots of brown fat). That means cold therapy helps white fat begin to burn more readily. Additionally, brown fat gain is associated with better insulin sensitivity.

Precautions When Taking the Plunge

It’s not hard to imagine that there may be some risks involved in ice bath therapy. It is submerging yourself in ice cold water after all! According to Dr. Corbett in a CNN article, cold therapy may have some of these side effects and risks:

Hyperventilation leading to metabolic alkalosis (a tissue pH above normal range)

Impaired consciousness (rare)

Reduction in cerebral artery blood flow which could cause fainting

Fast or abnormal heartbeat

Allergic and anaphylactic shock as well as the

Development of non-freezing cold injury (similar to frostbite but not as severe)

However, proponents of cold therapy argue that there are some safety precautions that can help avoid these risks.

Wim Hof of the Wim Hof Method recommends certain guidelines in his program to increase benefits and decrease risk (the 2nd video in his training is a safety video). However, safety in the cold tub varies according to individual tolerance.

Keep in mind too that many of the studies done on cold therapy and ice bath benefits were on healthy people. If you have any medical conditions, ice baths are probably not for you. (And certainly not if you are pregnant.) Always check with your doctor before trying a new therapy, especially one that involves exposure to extreme cold.

How to Do an Ice Bath for Health

If you’re willing to try an icy plunge for the promise of improved immunity and increased energy, here’s how to do it:

Work your way into it – Submerging in ice cold water is a definite shock to the system. Start by taking just a cold bath. Practice breathing normally and relaxing. You can increase the amount of ice you add to the bath as you get used to the water. You can also add more ice each time you try an ice bath. Even a bath at about 60 degrees has some benefits.

Move up to a cold plunge tub – For the full effect, you need a tub that allows you to submerge your whole body. You can make your own ice bath tub with a galvanized tub like this one. As you’ve seen on my Instagram, I use my Furo Health cold plunge tub several times a week and alternate it with our barrel sauna.

Follow safety guidelines – If you’re following any specific program (like Wim Hof) always follow the safety guidelines. In general, breathe normally and listen to your body.

Final Thoughts on This (Crazy) Cold Therapy

It may take some stoicism each time you get it, but the benefits of ice bathing and the way you feel after is so worth it. An improved immune system, better mental clarity and healthy, and improved metabolism are pretty enticing ice bath benefits and the reason I keep taking the plunge.

Have you ever tried an ice bath? What was your experience?

Sources:

Lateef F. (2010). Post exercise ice water immersion: Is it a form of active recovery?. Journal of emergencies, trauma, and shock, 3(3), 302. doi:10.4103/0974-2700.66570

Ihsan, M., Watson, G., Lipski, M., & Abbiss, C. R. (2013, May). Influence of postexercise cooling on muscle oxygenation and blood volume changes. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23247707

Mooventhan, A., & Nivethitha, L. (2014, May). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049052/

Urso, M. L. (2013, September). Anti-inflammatory interventions and skeletal muscle injury: Benefit or detriment? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23539314

Bleakley, C. M., & Davison, G. W. (2010, March 01). What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review. Retrieved from http://bjsm.bmj.com/content/44/3/179

Buijze, G. A., Sierevelt, I. N., Bas C. J. M. van der Heijden, Dijkgraaf, M. G., & Frings-Dresen, M. H. (2016). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025014/

Cool Temperature Alters Human Fat and Metabolism. (2015, May 15). Retrieved from https://www.nih.gov/news-events/nih-research-matters/cool-temperature-alters-human-fat-metabolism

Dunne, A., Crampton, D., & Egaña, M. (2013, September). Effect of post-exercise hydrotherapy water temperature on subsequent exhaustive running performance in normothermic conditions. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23246445

Source: https://wellnessmama.com/404091/ice-bath-benefits/

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