Focused assessment with sonography for trauma: Difference between revisions

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[[file:UOTW_18_-_Ultrasound_of_the_Week_1.webm|thumb|UOTW 18 - Ultrasound of the Week 1.webm]] [[file:UOTW_18_-_Ultrasound_of_the_Week_2.webm|thumb|UOTW 18 - Ultrasound of the Week 2.webm|left]] [[file:UOTW_18_-_Ultrasound_of_the_Week_3.webm|thumb|UOTW 18 - Ultrasound of the Week 3.webm]] [[file:FAST_Algorithm.svg|thumb|FAST Algorithm|left]] '''Focused Assessment with Sonography for Trauma (FAST)'''
[[File:UOTW 18 - Ultrasound of the Week 1.webm|thumb]] [[File:UOTW 18 - Ultrasound of the Week 2.webm|thumb]] [[File:UOTW 18 - Ultrasound of the Week 3.webm|thumb]] [[File:FAST Algorithm.svg|thumb]] Focused Assessment with Sonography for Trauma (FAST)


[[File:FAST scan.jpg|thumb|right|FAST scan being performed on a patient]]
Focused Assessment with Sonography for Trauma (FAST) is a rapid bedside ultrasound examination performed by clinicians to assess patients for internal bleeding, particularly in the setting of trauma. It is a critical component of the initial evaluation of trauma patients, especially those with blunt abdominal trauma, and is used to quickly identify free fluid in the peritoneal, pericardial, and pleural cavities.


'''Focused Assessment with Sonography for Trauma (FAST)''' is a rapid bedside ultrasound examination used by [[emergency medicine]] and [[trauma surgery|trauma surgeons]] to evaluate patients for internal bleeding, particularly in the [[peritoneal cavity]] and [[pericardium]]. The primary goal of the FAST exam is to quickly identify the presence of free fluid, which is often indicative of hemorrhage.
== History ==
The FAST examination was developed in the 1990s as a non-invasive, rapid, and repeatable method to assess trauma patients. It has since become a standard part of the Advanced Trauma Life Support (ATLS) protocol. The technique was initially popularized in Europe and Japan before gaining widespread acceptance in North America.


==History==
== Indications ==
The FAST exam was developed in the 1990s and has since become a standard component of the initial assessment of trauma patients. It has largely replaced [[diagnostic peritoneal lavage]] (DPL) due to its non-invasive nature and ability to be performed rapidly at the bedside.
FAST is indicated in the following scenarios:


==Technique==
* '''Blunt abdominal trauma''': To assess for hemoperitoneum.
The FAST exam involves the use of a portable [[ultrasound]] machine to scan four primary areas:
* '''Penetrating trauma''': To evaluate for pericardial effusion or hemothorax.
* The [[perihepatic]] and [[hepatorenal recess]] (also known as [[Morison's pouch]])
* '''Hypotension of unknown origin''': To quickly identify potential sources of internal bleeding.
* The [[perisplenic]] area
* '''Monitoring''': To track changes in fluid status in trauma patients.
* The [[pelvis]] (including the [[pouch of Douglas]] in females and the [[rectovesical pouch]] in males)
* The [[pericardium]]


The extended FAST (eFAST) exam also includes an assessment of the [[thorax]] to identify [[pneumothorax]] and [[hemothorax]].
== Technique ==
The FAST examination involves scanning four primary areas:


==Indications==
1. '''Pericardial view (subxiphoid or parasternal)''': To assess for pericardial effusion.
The FAST exam is indicated in patients with:
2. '''Right upper quadrant (RUQ) view''': To evaluate the hepatorenal space (Morison's pouch) for free fluid.
* Blunt or penetrating [[abdominal trauma]]
3. '''Left upper quadrant (LUQ) view''': To assess the splenorenal space for free fluid.
* Unexplained [[hypotension]] in the context of trauma
4. '''Pelvic view''': To check for free fluid in the rectovesical pouch (in males) or the rectouterine pouch (in females).
* Suspected [[hemoperitoneum]]
* Suspected [[hemopericardium]]


==Advantages==
The examination is typically performed with the patient in the supine position, using a curvilinear or phased array transducer.
The advantages of the FAST exam include:
* Rapid and non-invasive
* Can be performed at the bedside
* No need for patient transport
* Can be repeated as needed
* High sensitivity and specificity for detecting free fluid


==Limitations==
== Interpretation ==
Despite its advantages, the FAST exam has limitations:
The presence of free fluid in any of the scanned areas is considered a positive FAST examination, suggesting internal bleeding. The absence of free fluid does not rule out injury, and further diagnostic imaging, such as a CT scan, may be necessary.
* Operator-dependent
* Limited by patient body habitus and subcutaneous emphysema
* May miss small amounts of free fluid
* Cannot identify the exact source of bleeding


==Related Pages==
== Limitations ==
* [[Ultrasound]]
While FAST is a valuable tool, it has limitations:
* [[Trauma surgery]]
 
* [[Emergency medicine]]
* '''Operator dependency''': The accuracy of the examination depends on the skill and experience of the operator.
* [[Peritoneal cavity]]
* '''Limited sensitivity''': FAST may not detect small amounts of free fluid or retroperitoneal bleeding.
* [[Pericardium]]
* '''Obesity and subcutaneous emphysema''': These conditions can limit the quality of the ultrasound images.
* [[Pneumothorax]]
* [[Hemothorax]]
* [[Hemoperitoneum]]
* [[Hemopericardium]]


==See Also==
== Extended FAST (E-FAST) ==
* [[Extended Focused Assessment with Sonography for Trauma (eFAST)]]
The Extended FAST (E-FAST) includes additional views to assess for pneumothorax and hemothorax. This extension involves scanning the anterior chest wall to look for the "lung sliding" sign, which is absent in pneumothorax.
* [[Diagnostic peritoneal lavage]]
* [[Trauma triage]]
* [[Blunt trauma]]
* [[Penetrating trauma]]


==References==
== Also see ==
{{Reflist}}
* [[Ultrasound in trauma]]
* [[Advanced Trauma Life Support]]
* [[Hemoperitoneum]]
* [[Pericardial effusion]]
* [[Pneumothorax]]


==External Links==
{{Medical procedures}}
{{Commons category|Focused assessment with sonography for trauma}}
{{Trauma care}}


[[Category:Medical imaging]]
[[Category:Medical ultrasound]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Trauma surgery]]
[[Category:Trauma surgery]]
[[Category:Ultrasound]]
{{medicine-stub}}

Latest revision as of 15:33, 9 December 2024

File:UOTW 18 - Ultrasound of the Week 1.webm File:UOTW 18 - Ultrasound of the Week 2.webm File:UOTW 18 - Ultrasound of the Week 3.webm

Focused Assessment with Sonography for Trauma (FAST)

Focused Assessment with Sonography for Trauma (FAST) is a rapid bedside ultrasound examination performed by clinicians to assess patients for internal bleeding, particularly in the setting of trauma. It is a critical component of the initial evaluation of trauma patients, especially those with blunt abdominal trauma, and is used to quickly identify free fluid in the peritoneal, pericardial, and pleural cavities.

History[edit]

The FAST examination was developed in the 1990s as a non-invasive, rapid, and repeatable method to assess trauma patients. It has since become a standard part of the Advanced Trauma Life Support (ATLS) protocol. The technique was initially popularized in Europe and Japan before gaining widespread acceptance in North America.

Indications[edit]

FAST is indicated in the following scenarios:

  • Blunt abdominal trauma: To assess for hemoperitoneum.
  • Penetrating trauma: To evaluate for pericardial effusion or hemothorax.
  • Hypotension of unknown origin: To quickly identify potential sources of internal bleeding.
  • Monitoring: To track changes in fluid status in trauma patients.

Technique[edit]

The FAST examination involves scanning four primary areas:

1. Pericardial view (subxiphoid or parasternal): To assess for pericardial effusion. 2. Right upper quadrant (RUQ) view: To evaluate the hepatorenal space (Morison's pouch) for free fluid. 3. Left upper quadrant (LUQ) view: To assess the splenorenal space for free fluid. 4. Pelvic view: To check for free fluid in the rectovesical pouch (in males) or the rectouterine pouch (in females).

The examination is typically performed with the patient in the supine position, using a curvilinear or phased array transducer.

Interpretation[edit]

The presence of free fluid in any of the scanned areas is considered a positive FAST examination, suggesting internal bleeding. The absence of free fluid does not rule out injury, and further diagnostic imaging, such as a CT scan, may be necessary.

Limitations[edit]

While FAST is a valuable tool, it has limitations:

  • Operator dependency: The accuracy of the examination depends on the skill and experience of the operator.
  • Limited sensitivity: FAST may not detect small amounts of free fluid or retroperitoneal bleeding.
  • Obesity and subcutaneous emphysema: These conditions can limit the quality of the ultrasound images.

Extended FAST (E-FAST)[edit]

The Extended FAST (E-FAST) includes additional views to assess for pneumothorax and hemothorax. This extension involves scanning the anterior chest wall to look for the "lung sliding" sign, which is absent in pneumothorax.

Also see[edit]



Medical procedures
General
Diagnostic
Surgical
Non-surgical
Emergency


Template:Trauma care

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