FAT4

Ultrasound machine used in FAST

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Focused Assessment with Sonography for Trauma (FAST) is a rapid bedside ultrasound examination performed by medical professionals to assess patients with potential traumatic injuries. The primary goal of FAST is to identify the presence of free fluid, which is often indicative of internal bleeding, in the peritoneal, pericardial, or pleural spaces.

History

The FAST examination was developed in the 1990s as a quick and non-invasive method to evaluate trauma patients. It has since become a standard component of the Advanced Trauma Life Support (ATLS) protocol.

Indications

FAST is indicated in patients who have sustained blunt or penetrating trauma and are suspected of having internal bleeding. It is particularly useful in unstable patients where rapid decision-making is critical.

Technique

The FAST examination involves four primary views:

1. Perihepatic (Right Upper Quadrant) View: This view assesses the space between the liver and the right kidney, known as Morrison's pouch.
2. Perisplenic (Left Upper Quadrant) View: This view examines the area around the spleen and left kidney.
3. Pelvic View: This view checks for fluid in the rectovesical pouch in males or the rectouterine pouch (Pouch of Douglas) in females.
4. Pericardial View: This view evaluates the pericardial space for fluid around the heart.

Extended FAST (E-FAST)

The Extended FAST (E-FAST) includes additional views to assess for pneumothorax and hemothorax by examining the pleural spaces.

Advantages

FAST is a non-invasive, rapid, and repeatable procedure that can be performed at the bedside. It does not expose the patient to radiation and can be used in various settings, including the emergency department and pre-hospital environments.

Limitations

FAST may not detect small amounts of fluid or injuries that do not result in free fluid. Operator skill and experience can also affect the accuracy of the examination.

Clinical Significance

FAST is a critical tool in the initial assessment of trauma patients. It helps guide further diagnostic testing and management, such as the decision to perform a computed tomography (CT) scan or exploratory surgery.

Also see

• Ultrasound
• Trauma surgery
• Emergency medicine
• Advanced Trauma Life Support