FAST scan - US Flashcards
Three places/spaces you look for abdominal free fluid with POCUS?
RUQ - hepatorenal
LUQ - splenorenal
Suprapubic / Pelvic View
Space you’re looking for fluid in the RUQ?
The hepatorenal space (interface between the kidney and liver)
- important to visualize the tip of the liver as well as the inferior pole of the kidney to have an adequate assessment of the hepatorenal space
PS - diaphragm is the bright white line just superior to the liver
Colour of blood/fluid on US?
bonus: what does gas look like on US?
appears black (does not reflect sound)
bonus: Gas – scatters sound “grey snowstorm”
eFAST - “extended Focussed Assessment with Sonography in Trauma”
- three organs/areas you assess?
Abdo, Heart, Lung
- 3 views of the ABDO to detect
intraperitoneal peritoneal free fluid - Subxiphoid view of the HEART to detect cardiac
activity and pericardial effusion - Transthoracic view of the LUNG to detect
pneumothorax
How much fluid in the abdo can POCUS reliably detect?
POCUS can reliably detect 500 cc of free
intraperitoneal fluid
What is the view called when looking at Heart for
Pericardial Effusion & Cardiac Activity?
Subxiphoid view
High or low frequency probes used for each?
abdo - high/low?
cardiac - high/low?
lung - high/low?
abdo - low
cardiac - low
lung - high (High frequency linear array probe is ideal), linear probe is just flat as opposed to curvilinerar, and the frequency is the literal number written on the probe, higher number.
Thoracic View for Pneumothorax - Where should you place the probe, anterior or axillary?
Place probe on most anterior part of thoracic
cavity (when patient in a supine position) in
the midclavicular line… b/c air rises…
If no pneumothorax, what do you see?
Lung sliding and comet tails are reassuring for
no pneumothorax
Can also record motion, press “M mode”, press again, records a line graph basically.. “seashore sign” is positive for motion (waves on the beach)
What test do you order next for a stable patient with a positive FAST scan for abdominal free fluid?
A stable patient with free intraabdominal fluid should undergo further diagnostic testing such as CT to ascertain the specific injury.
If they’re hypotensive with free fluid, you should probably call a surgeon ASAP.
What must you check in the RUQ before you can clear that quadrant?
Tip of the liver
- can have fluid there even if hepatorenal space has none
There’s a rib in the way of your US probe, tough to clear the space, what can you do to get a better view?
Ask patient to take a deep breath and hold, or breath out and hold.
What specifically is the littlest cardiac probe good for?
motion!
What two settings should you normally use to try to optimize your picture/view when doing US?
depth and white balance (exposure)
