Chapter 189 - TFAST & AFAST in the ICU

Question 1

Suggested order of assessing AFAST sites

Answer 1

subxiphoid view first to identify the gallbladder and adjust gain setting, then any order

Question 2

list AFAST sites

Answer 2

subxiphoid (diaphragmaticohepatic)
left flank (splenorenal)
right flank (hepatorenal)
midline bladder (cystocolic)

Question 3

how does patient position affect the AFS

Answer 3

unknown - either lateral can be used

Question 4

possible causes of abdominal FF following trauma

Answer 4

hemorrhage > urinary tract rupture, biliary tract rupture, ruptured hollow viscus

Question 5

two most common sites of intraperitoneal haemorrhage in small animals following blunt trauma

Answer 5

splenic, hepatic injury

Question 6

sensitivity of FAST in retroperitoneal injury

Answer 6

low - suggest CT

Question 7

sensitivity and specificity of TFAST to detect pneumothorax

Answer 7

sens 78%, spec 93%

Question 8

differentials with loss of glide sign

Answer 8

pneumothorax, ARDS, pulmonary fibrosis, large consolidations, pleural adhesions, atelectasis, right mainstem bronchus intubation, phrenic nerve paralysis

Question 9

list TFAST sites

Answer 9

CTS bilat (dorsal third, widest point if lateral, 7-9th intercostal), PCS (5-6th intercostal over heart), subxiphoid AFAST site

Question 10

what does the bat sign represent

Answer 10

view of two ribs and intercostal window - white articorm outline of the ribs = the wings, white hypo echoic pleural line = the body. can be seen normally and with pleural space disease

Question 11

what are A lines?

Answer 11

reverberation line from soft tissue-air interface at the level of the pleural line - horizontal lines of decreasing echogenicity similar to and equidistant from pleural line 0 seen in patients with and without pneumothorax

Question 12

what are B lines?

Answer 12

a type of comet tail artifact originating from the visceral pleura, pass through the A lines without fading and move synchronously with glide sign - excessive B-lines = interstitial-alveolar lung disease

Question 13

what is B pattern

Answer 13

numerous B lines adjacent to each other, aka ultrasound lung rockets

Question 14

what is the lung curtain

Answer 14

movement of the lungs at the costophrenic angles - vertical sliding artefact similar to opening and closing of a theater curtain, not to be confused with the glide sign - move probe dorsally

Question 15

what are the ultrasonographic signs of pneumothorax?

Answer 15

strongly suspected if there is absence of glide signs and B lines, definitively compared with the lung point is seen - point at which the glide sign returns