FAST Ultrasound

Question 1

What does FAST stand for

Answer 1

Focused Assessment with Sonography for Trauma

Question 2

What is FAST

Answer 2

It is U/S that is performed as part of the examination and resuscitation of the trauma patient

Question 3

What is the purpose of the e-FAST

Answer 3

It is used when extra views are added to assess for pneumothorax

Question 4

What is the purpose of FAST

Answer 4

To determine the presence of free fluid

Question 5

How does FF (free fluid) appear on U/S

Answer 5

It is hypoechoic (dark grey) or anechoic (black)

Question 6

What is the only contraindication for efast

Answer 6

Need for immediate surgery

Question 7

5 indications of FAST

Answer 7

• Blunt and penetrating trauma
• trauma in pregnancy
• trauma in pediatrics
• undifferentiated hypotension
• medical management of ascites

Question 8

List 2 types of probes based on frequency

Answer 8

High Frequency
Low frequency

Question 9

Discuss the advantages and disadvantages of high frequency vs low frequency probes

Answer 9

High frequency: low depth, high resolution

Low frequency: high depth, low resolution

Question 10

List two types of “array” probes

Answer 10

Curvilinear Array (abdominal)
Small Footprint phased-array (cardiac)

Question 11

List the 4 windows in FAST

Answer 11

• subxiphoid
• RUQ
• LUQ
• pelvic/ suprapubic

Question 12

True or False

Answer 12

Clotted blood may appear echogenic

Question 13

How do you describe a positive FAST

Answer 13

Any view that reveals an anechoic collection

Question 14

How do you describe a negative FAST

Answer 14

If all views show no FF

Question 15

How do you describe an indeterminate fast?

Answer 15

If any one view of the FAST cannot be adequately assessed

Question 16

List 6 advantages of FAST

Answer 16

Easy to use
Portable
Noninvasive
Inexpensive
No ionizing radiation
Repeatable at bedside

Question 17

List 7 limitations of FAST

Answer 17

Sensitivity of 63-100%
Not definitive in ruling out intraabdominal injury
Can give false negatives:
- Diaphragm tears
- pancreatic lesions
- bowel perforations
- mesenteric trauma
Abd injuries that do not produce detectable amount of blood (>200ml)
Cannot distinguish between urine and blood
Limited by pt comorbidities

Question 18

Which comorbidities can limit the effectiveness of FAST

Answer 18

Severe obesity
Subcutaneous emphysema
Hyper inflated lungs from COPD

Question 19

What are the steps in the general technique for FAST

Answer 19

• patient supine
• rt side of patient
• ask pt to place arm behind head
• Trendelenburg position

Question 20

What manouvre improves the sensitivity of the FAST?

Answer 20

Trendelenburg

Question 21

What are the steps to obtaining the subxiphoid view in FAST

Answer 21

• asses the pericardial space
• place transducer inferior and to the right of the pt xiphoid process
• aim the beam towards the left shoulder

(Hold breathe on inspiration)

Question 22

What structures are seen in the subxiphoid view of FAST

Answer 22

All 4 heart chambers
Liver (at the top of the screen)

Question 23

The subxiphoid view can be difficult in which patients

Answer 23

Obese
Prominent xiphoid process
Large volume of stomach gas
Small xiphoid angle
Tender or distended abdomen

Question 24

Where is the probe positioned in the right upper quadrant view

Answer 24

Mid axillaire line
10th intercostal space
Probe pointing towards the patient’s head

Question 25

What are the four spaces evaluated

Answer 25

Pleural Subphrenic Hepatorenal (Morrison’s Pouch) Inferior pole of right kidney

Question 26

The “Spine Sign “ indicates what

Answer 26

This sign indicates that there is fluid in the lungs or pleural spaces that is allowing for transmission of the U/S waves to be able to view the vertebra (not normal obviously)

Question 27

What signs are seen in RUQ with a haemothorax

Answer 27

Anechoic line superior to the diaphragm

Question 28

Where is the probe place in the LUQ view

Answer 28

Posterior axillaire Line 8th intercostal space Probe marker pointing to head

Question 29

What are the four spaces evaluated in the LUQ view

Answer 29

Pleural Subphrenic Splenorenal Inferior pole of left kidney

Question 30

Where is the probe placed in the Pelvic view

Answer 30

Abdominal midline Superior to pubic symphysis Probe market to pts right Rotate probe 90 degrees

Question 31

Where is the probe place in e fast

Answer 31

3rd/ 4th ICS MCL

Question 32

The diagnosis of Pneumothorax on B- Mode depends on the presence of what features

Answer 32

Identification of pleural membrane Absent lung sliding Absent Comet Tail Artifact

Question 33

The presence of a pneumot in M-Mode is confirmed by the presence of what feature

Answer 33

“Bar code sign “- Stratosphere sign

Question 34

In a haemodynamically unstable pt who had blunt abdominal trauma with a positive FAST, what is the next step

Answer 34

Laparotomy !!!!

Question 35

In a haemodynamically unstable pt who had blunt abdominal trauma with a negative FAST, what is the next step

Answer 35

Consider: Non- Haem shock Other sites of blood loss Repeat FAST

Question 36

In a haemodynamically stable pt who had blunt abdominal trauma with a positive FAST, what is the next step

Answer 36

CT Scan

Question 37

In a haemodynamically stable pt who had blunt abdominal trauma with a negative FAST, what is the next step

Answer 37

Clinical observations Serial exams Repeat FAST CT SCAN