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 soundto-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 1- 3 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?