FAST Ultrasound Flashcards
What does FAST stand for
Focused Assessment with Sonography for Trauma
What is FAST
It is U/S that is performed as part of the examination and resuscitation of the trauma patient
What is the purpose of the e-FAST
It is used when extra views are added to assess for pneumothorax
What is the purpose of FAST
To determine the presence of free fluid
How does FF (free fluid) appear on U/S
It is hypoechoic (dark grey) or anechoic (black)
What is the only contraindication for efast
Need for immediate surgery
5 indications of FAST
- Blunt and penetrating trauma
- trauma in pregnancy
- trauma in pediatrics
- undifferentiated hypotension
- medical management of ascites
List 2 types of probes based on frequency
High Frequency
Low frequency
Discuss the advantages and disadvantages of high frequency vs low frequency probes
High frequency: low depth, high resolution
Low frequency: high depth, low resolution
List two types of “array” probes
Curvilinear Array (abdominal)
Small Footprint phased-array (cardiac)
List the 4 windows in FAST
- subxiphoid
- RUQ
- LUQ
- pelvic/ suprapubic
True or False
Clotted blood may appear echogenic
How do you describe a positive FAST
Any view that reveals an anechoic collection
How do you describe a negative FAST
If all views show no FF
How do you describe an indeterminate fast?
If any one view of the FAST cannot be adequately assessed
List 6 advantages of FAST
Easy to use
Portable
Noninvasive
Inexpensive
No ionizing radiation
Repeatable at bedside
List 7 limitations of FAST
Sensitivity of 63-100%
Not definitive in ruling out intraabdominal injury
Can give false negatives:
- Diaphragm tears
- pancreatic lesions
- bowel perforations
- mesenteric trauma
Abd injuries that do not produce detectable amount of blood (>200ml)
Cannot distinguish between urine and blood
Limited by pt comorbidities
Which comorbidities can limit the effectiveness of FAST
Severe obesity
Subcutaneous emphysema
Hyper inflated lungs from COPD
What are the steps in the general technique for FAST
- patient supine
- rt side of patient
- ask pt to place arm behind head
- Trendelenburg position
What manouvre improves the sensitivity of the FAST?
Trendelenburg
What are the steps to obtaining the subxiphoid view in FAST
- asses the pericardial space
- place transducer inferior and to the right of the pt xiphoid process
- aim the beam towards the left shoulder
(Hold breathe on inspiration)
What structures are seen in the subxiphoid view of FAST
All 4 heart chambers
Liver (at the top of the screen)
The subxiphoid view can be difficult in which patients
Obese
Prominent xiphoid process
Large volume of stomach gas
Small xiphoid angle
Tender or distended abdomen
Where is the probe positioned in the right upper quadrant view
Mid axillaire line
10th intercostal space
Probe pointing towards the patient’s head
What are the four spaces evaluated
Pleural
Subphrenic
Hepatorenal (Morrison’s Pouch)
Inferior pole of right kidney
The “Spine Sign “ indicates what
This sign indicates that there is fluid in the lungs or pleural spaces that is allowing for transmission of the U/S waves to be able to view the vertebra (not normal obviously)
What signs are seen in RUQ with a haemothorax
Anechoic line superior to the diaphragm
Where is the probe place in the LUQ view
Posterior axillaire Line
8th intercostal space
Probe marker pointing to head
What are the four spaces evaluated in the LUQ view
Pleural
Subphrenic
Splenorenal
Inferior pole of left kidney
Where is the probe placed in the Pelvic view
Abdominal midline
Superior to pubic symphysis
Probe market to pts right
Rotate probe 90 degrees
Where is the probe place in e fast
3rd/ 4th ICS MCL
The diagnosis of Pneumothorax on B- Mode depends on the presence of what features
Identification of pleural membrane
Absent lung sliding
Absent Comet Tail Artifact
The presence of a pneumot in M-Mode is confirmed by the presence of what feature
“Bar code sign “- Stratosphere sign
In a haemodynamically unstable pt who had blunt abdominal trauma with a positive FAST, what is the next step
Laparotomy !!!!
In a haemodynamically unstable pt who had blunt abdominal trauma with a negative FAST, what is the next step
Consider:
Non- Haem shock
Other sites of blood loss
Repeat FAST
In a haemodynamically stable pt who had blunt abdominal trauma with a positive FAST, what is the next step
CT Scan
In a haemodynamically stable pt who had blunt abdominal trauma with a negative FAST, what is the next step
Clinical observations
Serial exams
Repeat FAST
CT SCAN
