FAST Exam

Erin Carnes September 27, 2007

FAST Exam
Introduction Ultrasound Physics Technique Indications for FAST exam Performing a FAST exam Limitations Questions

What is the FAST exam?

Focused Assessment by Sonography in Trauma Focused exam using ultrasound to diagnose hemorrhage in a trauma setting Ideally takes < 3 min 4 primary views

RUQ LUQ Subxiphoid Suprapubic

Basic Ultrasound Physics

Ultrasound is a spectrum of sound frequencies above the human hearing range. Molecules must be present for sound to exist. Every object has an echogenicity. When sound waves hit the object some are transmitted through and some bounce back. Every substance will respond differently to the sound waves striking its surface. This occurs at every sound-to-sound interface and the reflection of sound waves can be used to create and image.

Technique

Goal: to identify blood in body cavities where it is not supposed to be

Unclotted blood appears black on US Clotted blood appears gray

Abdominal probe with small footprint (between 13 cm) with range of frequency between 2.0 Hz and 5.0 Hz Scan 4 areas

RUQ Subxiphoid LUQ Suprapubic

Indications
Blunt thoracoabdominal trauma Penetrating thoracoabdominal trauma Suspected pericardial tamponade Trauma patient with hypotension on unknown etiology Thoracoabdominal trauma in a pregnant patient

Right Upper Quadrant

Sagittal view obtained by placing probe either in the midclavicular line on the lower rib cage or below the right costal margin May have to move probe laterally to avoid gas in hepatic flexure Air-filled lung creates reflection artifact in which lung appears to be composed of liver parenchyma Scan for black fluid in potential spaces

Normal RUQ

Abnormal RUQ

Subxiphoid

Probe placed under xiphoid almost parallel with skin surface directed towards patients left shoulder Parasternal view may be used when supxiphoid unable to be obtained Consider pnuemothorax when unable to obtain images of heart and no apparent reason

Normal Subxiphoid

Abnormal Subxiphoid

Left Upper Quadrant

Most technically difficult to obtain Probe placed parallel with ribs in posterior axillary line Scan potential spaces between diaphragm and spleen and spleen and kidney for free fluid

Normal LUQ

Abnormal LUQ

Suprapubic
Entire pelvis should be

scanned from top to bottom with transducer in transverse place and them side to side with transducer in sagittal plane Pouch of Douglas is the most dependent site in peritoneal cavity First sign of blood is often two small black triangles on either side of rectum Bow tie sign

Normal Suprapubic

Abnormal Suprapubic

Limitations

Retroperitoneal bleeding Inadequate volume of fluid Not enough time elapsed since trauma to demonstrate bleeding Solid organ trauma with encapsulated bleeding Image quality dependent on quality of US machine and probe, body habitus of patient, physical injuries Scan and interpretation are operator dependent

Questions?