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    Emergency Ultrasound Aims: F A S T

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    Ryan Alvin
    The FAST exam is a focused abdominal sonography used to detect fluid in trauma patients. It involves using ultrasound to rapidly examine four areas: the right upper quadrant, left upper quadrant, pelvis, and pericardial sac. A positive FAST finds fluid in any view and indicates possible injury requiring further evaluation. It is a sensitive test but not definitive, and negative scans must be followed up with other imaging if clinical suspicion remains. Understanding anatomy, technique, limitations, and abnormal findings is key to effective use of the FAST exam for trauma assessment.

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    Emergency Ultrasound Aims: F A S T

    Uploaded by

    Ryan Alvin
    84 views8 pages
    The FAST exam is a focused abdominal sonography used to detect fluid in trauma patients. It involves using ultrasound to rapidly examine four areas: the right upper quadrant, left upper quadrant, pelvis, and pericardial sac. A positive FAST finds fluid in any view and indicates possible injury requiring further evaluation. It is a sensitive test but not definitive, and negative scans must be followed up with other imaging if clinical suspicion remains. Understanding anatomy, technique, limitations, and abnormal findings is key to effective use of the FAST exam for trauma assessment.

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    The FAST exam is a focused abdominal sonography used to detect fluid in trauma patients. It involves using ultrasound to rapidly examine four areas: the right upper quadrant, left upper quadrant, pelvis, and pericardial sac. A positive FAST finds fluid in any view and indicates possible injury requiring further evaluation. It is a sensitive test but not definitive, and negative scans must be followed up with other imaging if clinical suspicion remains. Understanding anatomy, technique, limitations, and abnormal findings is key to effective use of the FAST exam for trauma assessment.

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    Download as PDF, TXT or read online from Scribd
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    84 views8 pages

    Emergency Ultrasound Aims: F A S T

    Uploaded by

    Ryan Alvin
    The FAST exam is a focused abdominal sonography used to detect fluid in trauma patients. It involves using ultrasound to rapidly examine four areas: the right upper quadrant, left upper quadrant, pelvis, and pericardial sac. A positive FAST finds fluid in any view and indicates possible injury requiring further evaluation. It is a sensitive test but not definitive, and negative scans must be followed up with other imaging if clinical suspicion remains. Understanding anatomy, technique, limitations, and abnormal findings is key to effective use of the FAST exam for trauma assessment.

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    Emergency Ultrasound

    Aims
    

    To provide understanding of
    Advantages and Disadvantages of
    Modalities
    The Goals of the FAST Exam
    Indications for FAST
    Basic Relevant Anatomy
    Technique and Abnormal Findings
    Pitfalls & Pearls

    Trauma
    FAST / Chest

    The FAST Exam

    What is FAST?

     Focused

     Assessment

    (with)

     Sonography
    

    (for)

    
    

     Trauma

    What FAST is NOT!


    
    
    

    A definitive diagnostic investigation


    A substitute for CT
    The answer to all our problems

    A focused, goal directed, sonographic


    examination of the abdomen
    Goal is presence of haemoperitoneum
    or haemopericardium
    An extension of clinical examination
    Part of the Primary Survey of any
    patient with signs of shock or
    suspicion of abdominal injury

    Why FAST?
    

    
    

    20-43% of patients with significant


    abdominal injuries may initially have a
    normal physical examination
    These patients can deteriorate quickly
    despite benign initial examination
    FAST has been demonstrated to have
    Sensitivity 86-99% for haemoperitoneum
    Specificity 90-99% for haemoperitoneum

    Diagnostic Modalities in
    Blunt Abdominal Trauma

    Indications

    Acute Blunt or Penetrating Torso


    Trauma
    Subacute Torso Trauma

    Special Cases

    
    
    

    Diagnostic Peritoneal Lavage (DPL)


    CT Scan
    Ultrasound (FAST exam)

    Trauma in Pregnancy
    Paediatric Trauma

    Diagnostic Peritoneal
    Lavage
    

    Advantages

    Very sensitive for


    identifying intraperitoneal blood
    106 RBC/mm3
    approx. 20 ml blood
    in 1L lavage fluid
    Can be done at the
    bedside
    Can be done in 1015 minutes

    Disadvantages

    Advantages
    Can be performed in
    5 minutes at the
    bedside
    Non-invasive
    Repeat exams
    Sensitivity and
    specificity for free
    fluid equal to DPL
    and CT

    Overly sensitive,
    may result in too
    high a laparotomy
    rate
    Invasive
    Difficult in
    pregnancy, or with
    many prior
    surgeries
    Can not be repeated

    FAST
    

    CT Scan
    Advantages
    Identifies specific
    injuries
    Good for hollow
    viscus and
    retroperitoneal
    injury
    High sensitivity and
    specificity

    Disadvantages
    Expensive
    equipment
    30-60 minutes to
    complete study
    Only for stable
    patients
    Not for pregnant
    patients

    Anatomy
    

    Disadvantages
    Operator dependent
    May not identify
    specific injury
    Poor for hollow
    viscus or
    retroperitoneal
    injury
    Obesity,
    subcutaneous air
    may interfere with
    exam

    In the supine patient, particular areas


    of the abdominal cavity are dependent
    Intraperitoneal fluid will pool in these
    areas and can be detected on
    Ultrasound

    Anatomy Tranverse
    Section

    Anatomy Longitudinal
    Section

    Anatomy Right
    Paramedian Section

    FAST The views


    

    Consists of 4 views

    RUQ (Morisons
    Pouch / Perihepatic)

    LUQ (Splenorenal /
    Perisplenic)

    Pelvic
    Sub-xiphoid

    FAST
    

    Increased sensitivity
    with increased number
    of views
    Will identify pleural
    effusions
    Reliably detects as little
    as 50-100cc in the
    thorax
    Sensitivity >96%,
    specificity 99-100%

    Perihepatic Window
    

    Transducer positioned
    in right posterioraxillary line between
    11th and 12th ribs with
    beam in coronal plane
    (level with xiphisternum)
    Panning beam in this
    plane demonstrates
    liver, kidney and
    diaphragm

    Abnormal Perihepatic
    View

    Perihepatic Window

    Perisplenic Window
    

    
    

    Perisplenic Window

    Transducer positioned in
    left posterior axillary line
    between 10th and 11th
    ribs with beam in coronal
    plane.
    Demonstrates spleen,
    kidney and diaphragm
    May be marred by
    acoustic shadows from
    ribs
    May be improved by
    imaging patient whilst in
    full inspiration.

    Abnormal Perisplenic
    View

    Pelvic Window
    

    Transducer placed
    transversely in midline
    approx 4 cm superior
    to symphysis pubis
    Angled downwards into
    pelvis to demonstrate
    bladder, rectum &
    rectovesical pouch
    Probe rotated thru 90o
    to move beam into
    sagittal plane

    Pelvic Window

    Abnormal Pelvic View

    Pericardial Window

    Pericardial Window

    Transducer placed in
    subxiphoid region of
    chest with beam
    projecting in coronal
    plane
    Demonstrates liver
    and heart

    Abnormal Pericardial
    View

    Sub-Xiphoid View

    Interpretation
    

    Positive FAST Scan


    Detection of intraperitoneal free fluid on any of
    the 3 abdominal windows or pericardial fluid on
    the pericardial window

    Negative FAST Scan


    Absence of intraperitoneal free fluid on any of
    the 3 abdominal windows and pericardial fluid on
    the pericardial window

    Equivocal or Indeterminate FAST Scan


    Any of windows is inadequately visualised and
    no fluid is seen on those that are well visualised

    Pitfalls & Pearls

    Application
    + Pericardial fluid
    Stable
    +IP fluid
    Unstable

    Theatre
    CT
    Theatre

    Results
    N= 1540 pts, 80/1540 (5%) with FF
    Overall: Sens 83.3%, Spec 99.7%
    PPV 95%, NPV 99%
    Precordial/Transthor : Sens 100%, Spec 99.3%
    Hypotensive BAT: Sens 100%, Spec 100%

    FAST is a RULE IN
    Test
    Gives answer of
    Yes or Cant be
    ruled out
    Haemoperitoneum
    is not present in all
    visceral injuries

    Injury

    %
    Absence
    of
    haemoper
    itoneum

    % of
    those
    requiring
    surgery

    Splenic

    27%

    15%

    Hepatic

    34%

    0%

    Pancreatic 29%

    0%

    Renal

    16%

    48%

    Pifalls & Pearls


    

    Dont over rely on scans


    Each FAST series is only a single data
    point in the clinical course of the patient

    Pitfalls & Pearls


    

    CT can detect volumes of free fluid as


    low as 100ml
    FAST can detect between 100-250ml
    0.5cm in Morisons Pouch = 500ml
    1cm in Morisons Pouch = 1000ml

    Pitfalls & Pearls


    

    Certain injuries may not initially be well


    detected by ultrasound

    Perforation of a hollow viscus


    Bowel wall contusion
    Pancreatic Trauma
    Renal pedicle injury
    Diaphragmatic disruption

    FAST does not image the retroperitoneal


    space well

    Pitfalls & Pearls


    

    Pitfalls & Pearls


    

    Certain normal anatomical structures may


    be mistaken for intraperitoneal free fluid

    
    

    Gallbladder
    Hepatic flexure of colon
    Stomach
    Seminal vesicles

    Premenopausal women may have a baseline


    quantity of free fluid in the pelvis
    Potential for False Positive Results

    Pneumothorax

    Beware the excessively full bladder


    Traditionally pelvic window best imaged
    with full bladder
    A Grossly distended bladder may
    obliterate the rectovesical pouch and
    empty it, giving a False Negative result
    A partially voided study may increase
    sensitivity

    
    

    Gliding sign
    Comet tails

    Conclusion
    
    
    
    
    

    FAST is a rapid and safe extension of


    Primary Survey
    It should be used as a Rule In test
    Dont be afraid to repeat it or proceed to
    other imaging modalities
    Scans should be classified as positive,
    negative or equivocal/indeterminate
    Be aware of the causes of false positive and
    negative results

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