Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition

Summary

The Focused Assessment with Sonography for Trauma (FAST) exam is a diagnostic point-of-care ultrasound examination used to screen for the presence of free fluid in the pericardium and peritoneum. Indications, techniques, and pitfalls of the procedure are discussed in this article.

Abstract

Over the past twenty years, the Focused Assessment with Sonography for Trauma (FAST) exam has transformed the care of patients presenting with a combination of trauma (blunt or penetrating) and hypotension. In these hemodynamically unstable trauma patients, the FAST exam permits rapid and noninvasive screening for free pericardial or peritoneal fluid, the latter of which implicates intra-abdominal injury as a likely contributor to the hypotension and justifies emergent abdominal surgical exploration. Further, the abdominal portion of the FAST exam can also be used outside of the trauma setting to screen for free peritoneal fluid in patients who become hemodynamically unstable in any context, including after procedures that may inadvertently injure abdominal organs. These "non-trauma" situations of hemodynamic instability are often triaged by providers from specialties other than emergency medicine or trauma surgery who are not familiar with the FAST exam. Therefore, there is a need to promulgate knowledge about the FAST exam to all clinicians caring for critically ill patients. Toward this end, this article describes FAST exam image acquisition: patient positioning, transducer selection, image optimization, and exam limitations. Since the free fluid is likely to be found in specific anatomic locations that are unique for each canonical FAST exam view, this work centers on the unique image acquisition considerations for each window: subcostal, right upper quadrant, left upper quadrant, and pelvis.

Introduction

The Focused Assessment with Sonography for Trauma (FAST) exam is a diagnostic point-of-care ultrasound (POCUS) exam of the torso designed to rapidly assess potentially life-threatening hemorrhage in trauma patients¹. The FAST exam was one of the earliest POCUS techniques to achieve widespread adoption: it was first developed in the 1980s in Europe and spread to the United States in the early 1990s. As POCUS became more commonly utilized in the evaluation of trauma patients, a consensus conference was held in 1997, which standardized the definition of the FAST exam and its role in the care of trauma patients. Over time, some authors have advocat....

Protocol

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The patients provided written informed consent for participating in the study. Patient inclusion criteria: any patient with hemodynamic instability or abdominal pain/distension. Patient exclusion criteria: patient refusal.

1. Transducer selection

1. Select a low-frequency linear transducer (1-5 MHz) (see Table of Materials) to visualize or....

Results

Four sonographic windows are typically used to obtain the traditional FAST exam views¹⁹. The windows are subcostal 4-chamber (SC4C), right upper quadrant (RUQ), left upper quadrant (LUQ), and suprapubic/pelvic. Although the windows can be imaged in any order, the exam is typically performed in the following order: SC4C, RUQ, LUQ, and then suprapubic/pelvic^1,19. This is because pericardial tamponade is usually more rapidly life-threatening .......

Discussion

Traumatic injuries remain a leading cause of morbidity and mortality in the United States and worldwide. The rapid evaluation of the trauma patient and identification of injuries, including major hemorrhage, is a key component of reducing trauma morbidity. The FAST exam rapidly and non-invasively screens for potential sources of life-threatening hemorrhage. Critical steps to the success of the procedure are obtaining all of the views through the four primary ultrasonographic windows and, if necessary, using the alternati.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Affiniti  (including linear high-frequency, curvilinear, and sector array transducers)	Philips	n/a	Used to obtain a subset of the Figures and Videos
Edge 1 ultrasound machine (including linear high-frequency, curvilinear, and sector array transducers)	SonoSite	n/a	Used to obtain a subset of the Figures and Videos
M9 (including linear high-frequency, curvilinear, and sector array transducers)	Mindray	n/a	Used to obtain a subset of the Figures and Videos
Vivid iq  (including linear high-frequency, curvilinear, and sector array transducers)	GE	n/a	Used to obtain a subset of the Figures and Videos