Resuscitation Ultrasound (resUS)
FAST
FAST stands for Focused Assessment with Sonography for Trauma.
- Hypotension after trauma
- Free fluid in the thorax or abdomen is assumed to be blood
- Positive FAST = fluid found in one or more windows
- Indication for operation
- Performed in abdominal presets/exam type
- Most systems have FAST exam type
- Phased Array in abdominal/FAST presets
- Curvilinear in abdominal/FAST presets
FAST and e-FAST Windows (Figures 1, 2)
- Evaluate the hepatorenal recess (Morrison’s Pouch) and lower right thorax
- Right anterior axillary line
- Indicator aimed up
- Find potential space between the liver and kidney (Figure 2)
- Look for a black stripe of fluid between the liver and kidney
- Evaluate the subphrenic space and splenorenal recess and lower left thorax
- Left anterior axillary line
- Indicator aimed up
- Find potential space between the spleen and kidney
- Look for black stripe of fluid
- Make sure to look above the spleen (Video 1)
- Evaluate the rectovesical pouch in male patients and rectouterine pouch of Douglas in female patients
- Transverse above the super pubic region
- Indicator to patient’s right
- Look for fluid around the bladder (Video 2)
- Evaluate the pericardium for effusion (tamponade) and evaluate for right heart strain (PE)
- 2 cm below the xiphoid
- Indicator to the patients right
- Angle under the xiphoid and then tilt up
- See the 4-chambers of the heart
- Look for fluid between the RV and the liver (Video 4)
- From the RUQ fan into the chest to look for hemothorax
- From the LUQ fan into the chest to look for hemothorax
- Look to the right and left of the sternum for lung sliding. Lack of sliding indicates possible pneumothorax (Video 4)
Figure 2 - Positive FAST in RUQ
Clip 2 - Positive FAST in Pelvis
Clip 3 - Positive FAST (Pneumothorax)
Clip 4 - Positive FAST in subxiphoid area (pericardiac fluid)
