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 it’s 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 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 patient’s 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?