FAST Examination

Question 1

When do you preform a FAST exam?

Answer 1

After blunt/penetrating trauma to the abdomen and you suspect there could be free intraperitoneal/pericardial fluid or pneumothorax.

Question 2

Where does fluid/air collect in the plural cavity?

Answer 2

Fluid - posteriorly as it is dense,

Air - anteriorly as it is less dense,

Question 3

Where does fluid accumulate in the RUQ?

Answer 3

1. Morison’s pouch (between liver and right kidney),
2. Anterior recess (liver tip)
3. Between diaphragm and liver

Question 4

Where does fluid accumulate in the LUQ?

Answer 4

1. Between spleen and diaphragm,

2. Linorenal interface (between spleen and left kidney)

Question 5

where does fluid accumulate in the plevis?

Answer 5

1. Pouch of douglas in women,

2. Rectovesical pouch in men

Question 6

What are the view points in the FAST exam and the Extended FAST exam (EFAST)?

Answer 6

FAST - RUQ, LUQ, Pelvis and inferior to xiphoid process.

EFAST - same as above but with imaging of the plural space too.

Question 7

What is the probe of choice?

Answer 7

Curvilinear

Question 8

What are the benefits and limitations of the EFAST exam?

Answer 8

Benefits - Rapid, non-invasive, radiation free and therefore safe in children and pregnant women.
Limitations - Both false positives and negatives can arise. It requires 100-200mls of fluid before visible on ultrasound.

Question 9

What is the management plan of a patient who is haemodynamically stabe?

Answer 9

Fast exam then CT

Question 10

what is the management plan of a patient who is haemodynamically unstable?

Answer 10

FAST exam then if positive - laparotomy or if negative - diagnostic peritoneal lavage

Question 11

What is the spine sign?

Answer 11

Indication of pleural effusion/haemothorax.