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E – FAST Extended – Focused Assessment with Sonography in
Trauma
DAN STEVENS, ED REGISTRAR SCGH
Indications
Chest trauma Abdominal trauma Others
Ectopic pregnancy Ruptured ovarian cyst Ascities Hypotension of unknown cause
Limitations
Operator dependent High sensitivity and specificity for intraperitoneal fluid
Doesn’t tell you what structures are involved Doesn’t tell you what the fluid is Significant injuries to structures can occur without free fluid
Clinical Questions
Is there free fluid? Peritoneal Pericardial Pleural
Is there a pneumothorax
How to Scan
Patient supine Low frequency curvilinear probe Transducer maker
Longitudinal Towards head
Transverse To patient right (9 O’clock
position)
Where to scan
1. RUQ2. LUQ3. Subxiphoid / subcostal4. Suprapubic – longitudinal5. Suprapubic – transverse6. Right 3rd to 4th intercoastal space,
mid clavicular line, longitudinal7. Left 3rd to 4th intercostal space,
anterior axillary line, longitudinal
Right Upper Quadrant
Transducer Coronally (longitudinally) Marker towards patients head Mid - axillary line Lower ribs Slide, rotate and Fan
4 review areas1. Hepato-renal recess (Morrisons
pouch)2. Inferior pole of kidney into right
paracolic gutter3. Below diaphragm4. Pleural cavity
Left Upper Quadrant
Transducer Coronal plane Marker cephald More superior than RUQ
6th – 9th intercostal spaces More posterior than RUQ
posterior axillary line 4 review areas
1. Pleural cavity2. Below the diaphragm (perisplenic
space)3. Between spleen and left kidney4. Inferior pole left kidney (left paracolic
gutter)
Subxiphoid / Subcostal – 4 chamber view
Transducer Transverse, marker to patients
liver Subxiphoid Directed towards patietns left
shoulder Liver as acoustic window May need to increase depth
Effusion = dark band (anechoic), that separates bright (hyperechoic) pericardium from heterogenous grey myocardium
Suprapubic - Long
Transducer Midline Marker towards patients head Caudal end of probe just superior to
pubic symphysis Fan left to right
Review areas Men
1. rectovesical space Women
1. vesicouterine space 2. rectouterine pouch (pouch of
Douglas)
Suprapubic - Trans
Transducer Midline Transverse Marker towards patients right Fan superior to inferior
Review area Posterior wall of bladder
Lung - Right Mid-clavicular line
Transducer Curvilinear (abdominal) Linear (vascular access) Longitudinal Marker towards patients head Reduce depth 3rd - 7th intercostal space (most
superior) mid-clavicular line
Review areas Marching ants Comet tails A lines
Lung – Left Anterior Axillary line
Transducer Curvilinear Linear Longitudinal 3rd – 4th intercostal space Anterior axillary line
M-Mode Waves at sea Waves at the beach
References
http://www.ultrasoundvillage.comBedside Ultrasound. Volume 1 Dawson, MallinPoint-of-Care Ultrasound. Soni, Arntfield, Kory