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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?