Table of Contents
What is included in a FAST exam?
The FAST exam evaluates the pericardium and three potential spaces within the peritoneal cavity for pathologic fluid. The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe.
What does a positive FAST exam mean?
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 peritoneum. In the right upper quadrant this typically appears in Morison’s Pouch (between the liver and kidney).
What is a FAST exam and why is it used?
The original papers describing the FAST (Focused Assessment with Sonography in Trauma) examination focused on identifying free intraperitoneal or pericardial fluid in blunt trauma patients.
What is FAST exam in trauma?
E-FAST (Extended Focused Assessment with Sonography in Trauma) is a bedside ultrasonographic protocol designed to detect peritoneal fluid, pericardial fluid, pneumothorax, and/or hemothorax in a trauma patient.
What is a limitation of a FAST exam?
The main limitation of the FAST examination is that the operator must be knowledgeable in its clinical use and be aware that it does not exclude all injuries. Limitations to the pericardial assessment for hemopericardium include pericardial fat pads, cysts, and preexisting pericardial fluid.
What does a negative FAST exam mean?
Indications. FAST is useful in patients with blunt or penetrating traumatic injury. Enables trauma bay decision: Stable patient with traumatic mechanism of injury + negative FAST → observation. Stable patient with traumatic mechanism of injury + positive FAST → CT.
How much fluid can a FAST exam detect?
In the detection of pleural effusion or hematothorax ultrasound can detect even the smallest amounts of fluid (20 ml) whereas you need 200ml to detect those pathologies with a chest X-Ray. The eFAST exam has largely replaced the peritoneal lavage as the primary method to detect free intraperitoneal fluid.
What are the indications for FAST scan?
Indications for FAST include evaluation of the torso for free fluid suggesting injury to the peritoneal, pericardial, and pleural cavities, particularly in cases of trauma. FAST examination may be used to evaluate the lungs for pneumothorax.
When is a FAST indicated?
The primary FAST examination classically includes the subxiphoid window of the heart to denote pericardial fluid. Indications for FAST include evaluation of the torso for free fluid suggesting injury to the peritoneal, pericardial, and pleural cavities, particularly in cases of trauma.
What do you do after a negative FAST exam?
In hemodynamically stable patients, a positive FAST exam- ination should be followed by an abdominal CT scan to better define the injury, and a negative FAST examination should be followed with serial exams for 6 hours and a follow-up ultrasound or abdominal CT scanning, depending on the clinical scenario.
Who can perform a FAST exam?
The FAST exam can be carried out quickly and reliably (both by radiologists and emergency physicians [8–13], at limited costs and without radiation exposure to the patient. Performing a FAST exam expedites time to definitive care [14–16], and thereby contributes to a better outcome for trauma patients.
What is the fast examination?
The philosophy behind the FAST examination is that fluid will pool in the most dependent areas. As a result, the FAST examination includes 3 views that can detect pooled blood (red lines) and one to evaluate the heart: the hepatorenal recess, the perisplenic view, the subxiphoid pericardial window, and the suprapubic window.
What are the guidelines for the fast examination of the heart?
Guidelines for FAST examination have been published by the American Institute of Ultrasound in Medicine (AIUM) and the American College of Emergency Physicians (ACEP). [ 9] The primary FAST examination classically includes the subxiphoid window of the heart to denote pericardial fluid.
Can a fast examination delay the initiation of emergency treatments?
When emergency treatments such as intravenous (IV) fluids or transfusion of blood are indicated, performance of a FAST examination should not delay the initiation of these treatments.
When is the best time to do a FAST exam?
Like all other procedures in medicine (including many physical exam techniques), experience is key. Practice doing FAST exams whenever you can – as you perform more and more, you will get faster at it and better able to recognize abnormalities. A great time to practice FAST exams is immediately after a trauma patient returns from the CT scanner.