FAST exam

Indication

• Prioritize: Do primary survery first ABC"U"D
• If blunt trauma start with noncardiac views first
• In penetrating start with cardiac views first - r/o tamponade
• Serial exams extremely helpful

Stable vs Unstable

Positive FAST (RUQ)

Positive FAST (RUQ)

Positive FAST (LUQ)

• Views: hepatorenal, splenorenal, pelvis, pericardium
• Stable patient + negative FAST → observation
• Stable patient + positive FAST → CT
• Unstable patient + negative fast → repeat FAST or DPL
• Unstable patient + positive FAST → laparotomy

Procedure

• Always point dot to pt Rt (usu at 45 degrees) or @ pt head
• Morison's Pouch
  • Best seen w/ probe around mid ax to ant ax line (esp w/ pt in trendelenburg)
  • Pitfall: fan completely through (must visualize liver tip), assess pleural space
• Ultrasound: Renal
• Splenorenal
  • Place probe in post ax line
  • Pitfall: Look superior to spleen for fluid, not just splenorenal
  • Troubleshooting: Slide probe as posteriorly as possible, have patient hold breath if able to
• Bladder
  • Pitfall: turn down gain to view posterior bladder (posterior acoustic enhancement)
  • Ultrasound: Bladder
• Cardiac
  • Assess for pericardial effusion
  • see Ultrasound: Cardiac
• E-FAST
  • Add on pulmonary views to evaluate for pneumothorax
  • Ultrasound: Lungs

See Also

• Ultrasound: Cardiac
• Ultrasound: IVC
• Ultrasound: Lungs
• Ultrasound (Main)
• Ultrasound: Renal
• Abdominal Trauma
• Ultrasound: In Shock and Hypotension

References

Sonoguide UTZ textbook