Focused assessment with sonography for trauma

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FAST Algorithm

Focused Assessment with Sonography for Trauma (FAST)

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FAST scan being performed on a patient

Focused Assessment with Sonography for Trauma (FAST) is a rapid bedside ultrasound examination used by emergency medicine and 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 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.

Technique

The FAST exam involves the use of a portable ultrasound machine to scan four primary areas:

• The perihepatic and hepatorenal recess (also known as Morison's pouch)
• The perisplenic area
• 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.

Indications

The FAST exam is indicated in patients with:

• Blunt or penetrating abdominal trauma
• Unexplained hypotension in the context of trauma
• Suspected hemoperitoneum
• Suspected hemopericardium

Advantages

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

Despite its advantages, the FAST exam has limitations:

• 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

• Ultrasound
• Trauma surgery
• Emergency medicine
• Peritoneal cavity
• Pericardium
• Pneumothorax
• Hemothorax
• Hemoperitoneum
• Hemopericardium

See Also

• Extended Focused Assessment with Sonography for Trauma (eFAST)
• Diagnostic peritoneal lavage
• Trauma triage
• Blunt trauma
• Penetrating trauma

External Links

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