FAST Dr. vinayak lokareJMMC & RI

Blunt abdominal trauma

Is there fluid within the peritoneal cavity?

Is there fluid in the pericardial sac?

FAST Focused assessment of the sonographic

examination of the trauma Rapid diagnostic examination to assess

patients with potential thoracoabdominal injuries

Surveys for the presence or absence of blood in the pericardial sac and dependent abdominal regions

Four areas examined sequentially in FAST – pericardial sac right upper quadrant (RUQ), left upper quadrant (LUQ), pelvis

Pericardial sac

First to be examined To set the gain – anechoic

3.5-MHz convex transducer positioned in the subxiphoid region

Difficulties severe chest wall injury, a very narrow subcostal area, subcutaneous emphysema, morbid obesity

parasternal US

False-positive and false-negative pericardial US examinations Massive hemothorax or Mediastinal blood

Repeating FAST after insertion of a tube thoracostomy

Right upper quadrant

The transducer is placed in the right midaxillary line between the 11th and 12th ribs

Liver, kidney, and diaphragm are viewed in the sagittal section

Morison's pouch and in the subphrenic space

Left upper quadrant

Transducer positioned in the left posterior axillary line between the 10th and 11th ribs

Spleen and kidney and the subphrenic space are visualized

Pelvis

Transducer is directed for a transverse view and placed about 4 cm cephalad to the symphysis pubis

It is swept inferiorly to obtain a coronal view of the full bladder and the pelvis to examine for the presence or absence of blood

Advantages Portable, Rapid,

Hemodynamically unstable patient Inexpensive, Accurate

Early diagnosis of hemopericardium before the patients underwent physiologic deterioration

Hypotensive patients

noninvasive, repeatable

Disadvantages

Operator variability Morbidly obese patients Those with large amounts of

subcutaneous air False-negative FAST

at least300 ml of fluid must be present before it can be reliably detected by FAST.

Comparison with CT FAST does not readily identify

intraparenchymal or retroperitoneal injuries

Indications of CT in false-negative FAST Fractures of the pelvis Fractures of thoracolumbar spine Major thoracic trauma (pulmonary

contusion, lower rib fractures) Hematuria

Hemothorax

Focused thoracic US examination Detect the presence or absence of

traumatic hemothorax in patients during the ATLS secondary survey Shortens the interval from the

diagnosis of hemothorax to tube thoracostomy insertion

Right and left lower thoracic areas in the mid to posterior axillary lines between the 9th and 10th intercostal spaces

Normal

Hemothorax

Pneumothorax

US examination indicated in 1.    Bulky radiology equipment is not

readily available   2.    Inordinate delays in obtaining a chest

radiograph are anticipated    3.    Numerous injured patients (mass

casualty situation) must be rapidly assessed and triaged

5.0- to 7.5-MHz linear-array transducer Third to fourth intercostal space in the

midclavicular line Presumed unaffected thoracic cavity is

examined first Normal examination

rib (seen as black on the US ) pleural sliding comet tail artifact

Comet tail appearance

Sternal Fracture

Visualized on a lateral x-ray view of the chest which is difficult to obtain in a multisystem-injured patient

5.0- or 8.0-MHz linear-array transducer

Beginning at the suprasternal notch transducer is slowly advanced caudally