View source for FAST Exam

Focused assessment with sonography in trauma (FAST) is a necessary skill for any physician managing trauma patients and should be thought of as an extension of the secondary survey. The goal of the exam is to rapidly assess for hemopericardium and intraperitoneal fluid, which in the setting of trauma is assumed to reflect internal bleeding. A curvilinear (abdominal) probe may be used though typically a phased array (cardiac) probe is preferred. 

There are 4 windows to evaluate during FAST exam:
#Cardiac window; typically obtained via subxiphoid view though can be obtained from parasternal window. This is to evaluate for pericardial effusion, which in the trauma patient is assumed to be hemopericardium.
#Hepatorenal recess (Morrison’s Pouch); located in RUQ abdomen. Sometimes included in this view is evaluation of the inferior tip of the liver, as blood can be seen here prior to pooling in regions that are more dependent.
#Splenorenal recess; located in LUQ abdomen. Often included in this evaluation is a view of the subphrenic space between diaphragm and spleen.
#Retrovesical (male) or rectouterine pouch (female); located in suprapubic region, evaluation looks for a ‘double bladder sign,’ which indicates fluid posterior to the bladder.

It is optimal to include views of the pleural lines using a vascular probe for evaluation of pneumothorax at the same time as the FAST exam, and is included in the eFAST exam. This study has greater sensitivity than CXR though less sensitivity than chest CT for pneumothorax. 

As the value of bedside US is dependent on the skill and experience of the ultrasonographer, providers working in the ER are encouraged to use US often to increase their proficiency.

[[Common ED Procedures]]