Ultrasound: Skills of carrying out Focused Assessment with Sonography in Trauma (FAST)

Author: John P Sloan / Editor: John P Sloan / Reviewer: James Waiting, Joe Schrieber / Codes: Published: 15/03/2021

Description:

FAST involves assessment of the peritoneal cavity, pleural cavity and pericardial space. Learning that free fluid is present facilitates the most appropriate management plan. Additionally, the ability to detect free fluid has wider application, e.g. in ruptured ectopic pregnancy.

Pre-requisites

  • Ultrasound: Indications
  • Ultrasound: Physics
  • Ultrasound: Image acquisition

After completing this session you will be able to:

  • Explain the indications for a FAST scan
  • Identify which probe to use and how to adjust the machine
  • Describe how to position the probe on the patient
  • Demonstrate Morrison’s pouch, the spleno-renal space, the pelvic cavity, the pericardial sac and the pleural cavity
  • Recognise the appearances of free fluid in these spaces
  • Evaluate when repeat or alternative imaging is required

References:

  1. Sloan, J.P. (May 2004) Emergency Physician directed Ultrasound. Ultrasound.
  2. Ma, O.J. et al. (1995) Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. Journal of  Trauma: Injury, Infection and Critical Care, 38(6), pp. 879-885.
  3. Jehle, D., Guarino, J. and Karamanoukian, H. (1993) Emergency department ultrasound in the evaluation of blunt abdominal trauma.  American Journal of Emergency Medicine, 11(4), pp. 342-346.
  4. McElveen, T.S. and Collin, G.R. (1997) The role of ultrasonography in blunt abdominal trauma: A prospective study. The American Surgeon, 63, pp. 184-188.
  5. McKenney, M.G. et al. (1996) 1,000 consecutive ultrasounds for blunt abdominal trauma. Journal of Trauma: Injury, Infection and Critical Care, 40(4), pp. 607-612.
  6. Chambers, J.A. and Pilbrow, W.J. (1998) Ultrasound in Abdominal Trauma: an alternative to peritoneal lavage. Archives of Emergency Medicine, 5, pp. 26-33.
  7. Brooks, A. et al. (2004) Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emergency Medicine Journal, 21, pp. 580-581.
  8. Brenchley, J. et al. (Jun 2006) Evaluation of focused assessment with sonography in trauma (FAST) by UK emergency physicians. Emergency Medicine Journal, 23, pp. 446-448.
  9. Yoshii, H. et al. (1998) Usefulness and limitation of ultrasonography in the initial evaluation of blunt abdominal trauma. Journal of Trauma: Injury, Infection and Critical Care, 45(1), pp. 45-51.
  10. Ingeman, J.E. et al. (1996) Emergency physician use of ultrasonography in blunt abdominal trauma. Academic Emergency Medicine, 3(10), pp. 931-937.
  11. Glaser, K. et al. (1994) Ultrasonography in the management of blunt abdominal and thoracic trauma. Archives of Surgury, 129, pp. 743-747.
  12. Tso, P. et al. (1992) Sonography in blunt abdominal trauma: a preliminary progress report. Journal of Trauma: Injury, Infection and Critical Care, 33, pp. 3944.
  13. Shackford, S.R. et al. (1999) Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum. Journal of Trauma: Injury, Infection and Critical Care, 46(4), pp. 553-562.
  14. Fleming S, Bird, R, Ratnasingham K et al, (2012) Accuracy of FAST scan in Blunt Abdominal Trauma in a Major London Trauma Centre Case series.  International Journal of Surgery, Vol 10, Issue 9, pp. 470-474
  15. Branney, S.W. et al. (Aug 1995) Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. Journal of Trauma, 39(2), pp. 375-380.

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