- The document discusses FAST (Focused Assessment with Sonography for Trauma), which is an ultrasound examination used to quickly assess potential injuries in trauma patients. It examines four areas: the pericardial sac, right upper quadrant, left upper quadrant, and pelvis to check for blood. - FAST has advantages of being portable, rapid, inexpensive, and allowing for early diagnosis. However, it has disadvantages like operator variability and potential for false negatives if less than 300ml of fluid is present. CT may be needed if FAST is negative but other indications suggest injury. Focused ultrasound can also detect hemothorax and pneumothorax.

1. FAST Dr. vinayak lokare JMMC & RI

2. Blunt abdominal trauma

3. Is there fluid within the peritoneal cavity? Is there fluid in the pericardial sac?

4. FAST F ocused a ssessment of the s onographic examination of the t rauma Rapid diagnostic examination to assess patients with potential thoracoabdominal injuries Surveys for the presence or absence of blood in the pericardial sac and dependent abdominal regions

5. Four areas examined sequentially in FAST – pericardial sac right upper quadrant (RUQ), left upper quadrant (LUQ), pelvis

7. Pericardial sac First to be examined To set the gain – anechoic 3.5-MHz convex transducer positioned in the subxiphoid region

9. Difficulties severe chest wall injury, a very narrow subcostal area, subcutaneous emphysema, morbid obesity parasternal US

11. False-positive and false-negative pericardial US examinations Massive hemothorax or Mediastinal blood Repeating FAST after insertion of a tube thoracostomy

12. Right upper quadrant The transducer is placed in the right midaxillary line between the 11th and 12th ribs Liver, kidney, and diaphragm are viewed in the sagittal section Morison's pouch and in the subphrenic space

14. Left upper quadrant Transducer positioned in the left posterior axillary line between the 10th and 11th ribs Spleen and kidney and the subphrenic space are visualized

16. Pelvis Transducer is directed for a transverse view and placed about 4 cm cephalad to the symphysis pubis It is swept inferiorly to obtain a coronal view of the full bladder and the pelvis to examine for the presence or absence of blood

18. Advantages Portable, Rapid, Hemodynamically unstable patient Inexpensive, Accurate Early diagnosis of hemopericardium before the patients underwent physiologic deterioration Hypotensive patients

19. noninvasive, repeatable

20. Disadvantages Operator variability Morbidly obese patients Those with large amounts of subcutaneous air False-negative FAST at least300 ml of fluid must be present before it can be reliably detected by FAST.

21. Comparison with CT FAST does not readily identify intraparenchymal or retroperitoneal injuries

22. Indications of CT in false-negative FAST Fractures of the pelvis Fractures of thoracolumbar spine Major thoracic trauma (pulmonary contusion, lower rib fractures) Hematuria

24. Hemothorax Focused thoracic US examination Detect the presence or absence of traumatic hemothorax in patients during the ATLS secondary survey Shortens the interval from the diagnosis of hemothorax to tube thoracostomy insertion Right and left lower thoracic areas in the mid to posterior axillary lines between the 9th and 10th intercostal spaces

26. Normal Hemothorax

27. Pneumothorax US examination indicated in 1. Bulky radiology equipment is not readily available 2. Inordinate delays in obtaining a chest radiograph are anticipated 3. Numerous injured patients (mass casualty situation) must be rapidly assessed and triaged

28. 5.0- to 7.5-MHz linear-array transducer Third to fourth intercostal space in the midclavicular line Presumed unaffected thoracic cavity is examined first Normal examination rib (seen as black on the US ) pleural sliding comet tail artifact

29. Comet tail appearance

30. Sternal Fracture Visualized on a lateral x-ray view of the chest which is difficult to obtain in a multisystem-injured patient 5.0- or 8.0-MHz linear-array transducer Beginning at the suprasternal notch transducer is slowly advanced caudally