Focused assessment with sonography for trauma

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"FAST scan" redirects here. For the stroke-related mnemonic, see FAST (stroke). For Fast-scan television, see Amateur television.
Focused assessment with sonography in trauma, a.k.a. FAST
Ultrasound image of a normal spleen that may be seen in part of the eFAST
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Focused assessment with sonography in trauma (commonly

trauma.[1][2] There is also the extended FAST (eFAST) which includes some additional ultrasound views to assess for pneumothorax.[3]

The four classic areas that are examined for free fluid are the perihepatic space (including Morison's pouch or the

bleeding
.

Indications

Reasons a FAST or eFAST would be performed would be:

  1. Blunt abdominal trauma
  2. Penetrating abdominal trauma
  3. Blunt thoracic trauma
  4. Penetrating thoracic trauma
  5. Undifferentiated shock (low blood pressure)[3]

Contraindications

Since the FAST/eFAST is performed with ultrasound, there is very little risk to the patient as ultrasounds only emit sound waves and record the echo to create a picture.[4] The most common contraindication would be delay of definitive care such as surgical intervention in the setting of obvious trauma or resuscitative efforts in an extreme scenario.[3]

Extended FAST

The eFAST allows for the examination of both

tension pneumothorax, a deadly complication if not treated immediately, and deterioration in the radiology suite (in the CT scanner).[8]

Components of the Examination

There are five components to the eFAST exam:

  1. Right Upper Quadrant of the abdomen (Perihepatic view). Right upper quadrant is examined by working your probe down the midaxillary line starting at the right 8th rib to the 11th rib. This examines for free fluid around the kidney and liver.
  2. Left Upper Quadrant of the abdomen (Perisplenic view). Left upper quadrant is examined by working your probe down the midaxillary line starting at the left 8th rib to the 11th rib. This examines for free fluid around the kidney and spleen.
  3. Pelvic views (Long and transverse axis). The suprapubic view helps assess for free fluid in the pelvic cavity.
  4. Cardiac view. The pericardial component is assessed using the subxiphoid view.
  5. Lung views (Right and Left, Long axis). These final views help determine if a pneumothorax is present.[9]

Findings

eFAST (extended focused assessment with sonography for trauma) allows an emergency physician or a surgeon the ability to determine whether a patient has pneumothorax, hemothorax, pleural effusion, mass/tumor, or a lodged foreign body. The exam allows for visualization of the echogenic tissue, ribs, and lung tissue. Few radiographic signs are important in any trauma and they include the stratosphere sign, the sliding or seashore sign, and the sinusoid sign.

Stratosphere sign is a clinical medical ultrasound finding usually in an eFAST examination that can prove presence of a pneumothorax. The sign is an imaging finding using a 3.5–7.5 MHz ultrasound probe in the fourth and fifth intercostal spaces in the anterior clavicular line using the M-Mode of the machine. This finding is seen in the M-mode tracing as pleura and lung being indistinguishable as linear hyperechogenic lines and is fairly reliable for diagnosis of a pneumothorax. Even though the stratospheric sign can be an indication of pneumothorax its absence is not at all reliable to rule out pneumothorax as definitive diagnosis usually requires X-ray or CT of thorax.[10][11][12]

Seashore sign is another eFAST finding usually in the lungs in the M-mode that depicts the glandular echogenicity of the lung abutted by the linear appearance of the visceral pleura. This sign is a normal finding. In absence of a seashore sign or presence of a stratosphere sign, pneumothorax is likely. B-lines or "comet trails" are echogenic bright linear reflections beneath the pleura that are usually lost with any air between the probe and the lung tissue and therefore whose presence with seashore sign indicates absence of a pneumothorax.[10][12]

Sinusoid sign is another

M-mode finding indicating presence of pleural effusion. Due to the cyclical movement of the lung in inspiration and expiration, the motion-time tracing (M-mode) ultrasound shows a sinusoid appearance between the fluid and the line tissue. This finding indicates a possible pleural effusion, empyema, blood in pleural space (hemothorax).[10][11]

Advantages

FAST is less invasive than

computed tomography, but achieves a similar accuracy.[13]

Numerous studies have shown FAST is useful in evaluating trauma patients.[14][15][16][17] It also appears to make emergency department care faster and better.[18][19]

  • Negative FAST but full stomach[20]
  • Negative FAST but full stomach[20]
  • Negative FAST but full stomach[20]

Interpretation

FAST Algorithm

FAST is most useful in trauma patients who are hemodynamically unstable. A positive FAST result is defined as the appearance of a dark ("anechoic") strip in the dependent areas of the

pelvis, blood generally pools behind the bladder (in the rectovesicular space). A positive result suggests hemoperitoneum; often CT scan will be performed if the patient is stable[21] or a laparotomy
if unstable. In those with a negative FAST result, a search for extra-abdominal sources of bleeding may still need to be performed.

See also

  • HEART scan

References

  1. ^ "Ultrasound in Trauma - The FAST Exam Focused Assessment with Sonography in Trauma". www.sonoguide.com. Archived from the original on 2008-09-14.
  2. ^ "Austere and Prehospital Ultrasound – The College of Remote & Offshore Medicine". Retrieved 2024-03-06.
  3. ^
    PMID 29261902
    .
  4. ^ "Ultrasound". National Institute of Biomedical Imaging and Bioengineering.
  5. ^ Kirkpatrick AW, Sirois M, Laupland KB, et al., J Trauma, 2004;57(2):288–95.
  6. ^ Zhang M, Liu ZH, Yang JX, et al., Crit Care, 2006;10(4):R112.
  7. ^ Blaivas M, Lyon M, Duggal SA, Acad Emerg Med, 2005;12(9):844–9.
  8. ^ Davis JA, et al. Critical Diagnosis in Bedside Ultrasonography. Diagnostics & Imaging. 2007.
  9. ^ [1], Patel D, Lewis K, Peterson A, Hafez M. Extended Focused Assessment with Sonography for Trauma (EFAST) Exam. J Med Ins. ;(299.6) doi:https://jomi.com/article/299.6
  10. ^
    ISBN 9781444397987
    .
  11. ^
    ISBN 9783805586429
    .
  12. ^ a b Steven G. Rothrock (M.D.) (2009). Tarascon Adult Emergency Pocketbook. Tarascon. p. 144.
  13. PMID 8576968
    .
  14. PMID 11231679
    .
  15. PMID 15798158
    .
  16. PMID 14990832
    .
  17. PMID 17976554
    .
  18. PMID 16934640
    .
  19. PMID 16612298
    .
  20. ^ a b c "UOTW #18 - Ultrasound of the Week". Ultrasound of the Week. 17 September 2014. Retrieved 27 May 2017.
  21. PMID 10088853
    .
Further reading

External links
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