Echo vs Urgent Echo

[eightiesboi]

Is it intended that there are symptoms that can only be diagnosed with an Echo but not an Urgent Echo? For example, the primary symptom of Congestive Heart Failure (CHF), "Heart Failing" cannot be diagnosed with an Urgent Echo. I actually had ruled out CHF early for one patient because the Urgent Echo came back negative; fortunately for my patient, I revisited this decision in time.

[jasonharris2]

Urgent Echo is a fast pass
Echo is a slower deeper pass

[eightiesboi]

Originally posted by jasonharris2:

Urgent Echo is a fast pass
Echo is a slower deeper pass

I am most definitely *not* a medical professional, and you may be, so apologies if so, but that isn't my understanding of the differences between Urgent Echo, which uses FAST, and a traditional Echo. In fact, the Radiology articles that I read seem to indicate that the biggest difference between modern FAST and Echo is the average level of training of the user. In fact, in the literature that I found, FAST is usually compared with CT when determining its advantages and drawbacks; FAST and traditional Echo were treated as generally similar, if not equivalent. But again, I am a layperson.

However, this still doesn't answer my question. :) Is it intended for there to be symptoms that are undetected by Urgent Echo but discovered only by Echo? If so, is that also true for FAST versus a regular USG?

[Oberkampfkater]

Heyho,

it puzzeled me at first too, but I think it is intended. Jasonharris2 seems to be quite right, the urgent echo is a more 'superficial' method then the standard echo procedure. Think about it that way: the urgent echo is used by a ED/IC doctor with no in-depth specialized training in sonography and is peformed on the fly (that's why FAST can be seen as quite literally here). The standard echography is done by a specialist with in-depth knowledge (over here, they tend to be doctors and not technicians) and in a more thorough way.

But you're right that a standard USG should uncover those symptoms that a FAST can uncover. I've to look into the database files to check this.

[Chicken Kickin Fun]

Urgent echo/fast is a quick do over to scan for any trauma inside. Echo's monitor the heart for a short while and can identify more issues as it's more thorough. there should be a chance to detect issues with fast/urgents depending on dr skill

[eightiesboi]

If @Oberkampfkater thinks it's intended behaviour, that's good enough for me! Thank you all for your responses! :)

[Oberkampfkater]

Heyho,

I've had a look into the database (symptoms_main.xml / symptoms.xml) and found some interesting stuff.

Most symptoms can be unvealed with both FAST USG and standard USG. Here is an example:

<GameDBSymptom ID="SYM_LIVER_LACERATION">
        <DescriptionLocID>SYM_LIVER_LACERATION_DESCRIPTION</DescriptionLocID>
        [...]
        <Examinations>
            <ExaminationRef>EXM_FAST</ExaminationRef>
            <ExaminationRef>EXM_USG</ExaminationRef>
        </Examinations>
       [...]
    </GameDBSymptom>

There is one symptom that can only be revealed by FAST USG and CT, not the standard USG. Maybe that's an oversight because I can't think of a reason that normal USG should not be able to find it:

<GameDBSymptom ID="SYM_BLUNT_SPLEEN_RUPTURE">
        <DescriptionLocID>SYM_BLUNT_SPLEEN_RUPTURE_DESCRIPTION</DescriptionLocID>
        [...]
        <Examinations>
            <ExaminationRef>EXM_FAST</ExaminationRef>
            <ExaminationRef>EXM_CT</ExaminationRef>
        </Examinations>
        [...]
      </GameDBSymptom>

Some symptoms (I've counted five) can only be uncovered by the standard echo USG and not the urgent one. Example:

<GameDBSymptom ID="SYM_HEART_FAILING">
        [...]
        <Examinations>
            <ExaminationRef>EXM_ECHO</ExaminationRef>
        </Examinations>
        [...]
    </GameDBSymptom>

There is no symptom that can only be uncovered by the urgent Echo.

That strongly suggests that this behaviour is intended. FAST USG and urgend USG unveil the obvious and most notable symptoms, the standard USG and standard Echo unveil everything (aside from one exception).

Edit: ah, those dreaded typos. ^^

[eightiesboi]

I noted much the same when I did my own .xml dive before my OP, although I came to the opposite conclusion... LOL. I figured it was possible that the fact that FAST / Urgent Echo had been left off of certain symptoms could have been simply a mistake. It is interesting about Blunt Spleen Rupture being detectable by FAST USG and CT, but not standard USG, seeing as my layperson's review of the literature indicated that there was really very little difference in detection capability from modern FAST and standard Ultrasound devices, and that the biggest difference was simply one of training.

Actually, one of the more interesting tidbits I picked was that, at least in the literature I read regarding efficacy studies and recommended procedures, if FAST was used in any capacity, regular Ultrasound was not used as a follow-up diagnostic tool; but rather CT was. FAST has a higher rate of false positives than CT (again, according to what I read), and therefore if the patient was stable, confirmation of a FAST diagnosis via CT was recommended. If the patient was not stable, a FAST diagnosis was sufficient for immediate surgery. Interestingly enough, if FAST was negative but the result was believed to be a potential false negative, the 2017 recommendation from the Radiological Society of North America was to repeat the FAST, perform a CT, or repeat the FAST but enhanced with a contrast medium. Following a negative FAST with traditional Ultrasound doesn't seem to be a thing, at least in the literature I read.

However, there are two important points: I am not a medical professional, and everything I've learned has been with internet research. I could be completely wrong in my understanding of the real world. Second, this is a game, and not a training simulation; therefore, the fact that there may be intentional variations from the real world is expected.

Finally, I just want to say that, @Oberkampfkater, you are a terrific asset to the community. There are a lot of great people on the boards here (way more than in most Steam forums!), but even taking that into consideration, you stand out. Thank you for taking the time to dive deeper into my question. :)