Bedside Fast Ultrasonography: Focused Assessment With Sonography For Trauma

imagesYes or No: Is there intra-abdominal fluid or fluid around the heart?


imagesThe assessment of blunt thoracoabdominal trauma with significant mechanism of injury


imagesThe assessment of penetrating torso trauma if operative management is not immediately indicated


CONTRAINDICATIONS



imagesThe FAST examination should never delay a patient’s transport to the operating room when operative management is clearly indicated


RISKS/CONSENT ISSUES



imagesThe only theoretical risk is allergy to the ultrasound gel


ADVANTAGES



imagesNoninvasive and no sedation required


imagesCan be performed at the bedside while resuscitative efforts are simultaneously being performed


imagesCan be performed at the bedside on patients too unstable for the computed tomographic imaging suite


imagesCan be repeated serially along with changes in symptoms or hemodynamic stability


LANDMARKS



imagesSubcostal


   imagesProbe placed in the subxiphoid region pointed toward the heart detects fluid in pericardial sac


imagesHepatorenal


   imagesProbe placed in the right midaxillary line between the 8th and 11th ribs detects fluid in the hepatorenal space (Morison pouch)


imagesSplenorenal


   imagesProbe placed in the left posterior axillary line between the 8th and 11th ribs detects fluid in the splenorenal recess


imagesSuprapubic


   imagesProbe placed 2 cm superior to the symphysis pubis detects fluid in the retrovesical or retrouterine space


TECHNIQUE



The standard four FAST views: Subcostal, hepatorenal pouch (Morison), splenorenal, and suprapubic (FIGURE 18.1)


imagesSubcostal/Subxiphoid View (FIGURE 18.2)


   imagesWith the probe in the transverse plane, place it in the subxiphoid area and aim toward the patient’s left shoulder to see a four-chambered view of the heart


   imagesSweep the probe anteriorly and posteriorly to view the entire pericardium


   imagesUnclotted blood will appear as an anechoic black “stripe” within the hyperechoic pericardial sac (FIGURE 18.3)



images


FIGURE 18.1 The four views of the FAST examination.



images


FIGURE 18.2 Subcostal view.

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Bedside Fast Ultrasonography: Focused Assessment With Sonography For Trauma
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