Emergency nurses who underwent training in focused assessment with sonography for trauma (FAST) scanning showed comparable accuracy to radiologists in identifying free fluid in trauma patients, with a sensitivity of 90% for both groups. While FAST scanning provides a rapid, portable, and inexpensive option for initial trauma evaluation, it does not identify the source of bleeding and has limitations in detecting certain injuries.

1. A Prospective evaluation of “focused assessment with
sonography for trauma” done by Emergency Nurses and its
comparative analysis with radiologists performance in
identifying fluid during initial resuscitation of trauma
 Bhoi S,SoniaChauhan, Geeta A,Shakuntla , Shoukkathali V,Sinha
Tej P, RK. Ramchandani
 Deptt. of Emergency Medicine,J P N Apex Trauma Center,AIIMS
 sonia_aiims@yahoo.co.in

2. Background
 Ultrasound has been used in the early assessment
of abdominal trauma.
 Emergency Ultrasound (EUS) helps the treating
clinician to identify emergent conditions thus
facilitating the rapid diagnosis and treatment of
critically ill patients
 Point of care sonography training to Emergency
Nurses in India would facilitate multiple skill
hands especially in mass casualty incidents.

3. Objective
 To determine the accuracy of emergency
nurses in detecting free fluid in abdomen
when compared to radiologist during primary
survey of trauma victims by focused
assessment with Sonography for trauma
[FAST] scan in the Emergency Department
[ED].

4. METHODOLOGY
• Study design- Qualitative prospective study
• Performance centre - ED of JPN Apex
Trauma Centre, AIIMS.
• Study duration-January to September 2011

5.  The study subjects included emergency Nurses (EN)
who underwent training at 3-day workshop on
emergency sonography
 They performed 10 supervised positive and negative
scans for free fluid.
 The FAST scans were first performed by the EN’s and
then by radiology resident (RR).
 Both were blinded to each other’s sonography
findings.
 CT scan and laparotomy findings were used as gold
standard whichever was feasible.
 Results were compared between both groups.

6. FAST
 Focused
 Assessment by
 Sonography in
 Trauma
AUTLS

7. FAST scan
 Minimal amount of fluid in abdomen detectable
by USG ~ 200 - 650ml
 High sensitivity in detecting hemoperitoneum
(63 -100% )
 High specificity in detecting hemoperitoneum
(96 - 99%)100%)
 Low sensitivity in detecting specific organ lesions
(<50%)

8. FAST Exam- Primary Views or
Windows
1. Subxiphoid
2. Right upper
quadrant (RUQ)
3. Left upper
quadrant (LUQ)
4. Suprapubic

9. FAST Exam - RUQ

10. FAST Exam - LUQ

11. FAST Exam – Supra-pubic
Transverse view

12. Results
 94 scans performed each by EN and RR were
analysed.
 Mean age of the patients was 29 [2 - 85] years.
 Out of 23 true positive patients 18 underwent CT
scan and exploratory laparotomy was done in 14
patients.
 Sensitivity of FAST done by EN and RR was 90 %.
 Specificity of FAST done by EN was 94.6 %Vs RR.
 Positive predictive value and negative predictive
values were 81.8% and 97.2% respectively

13.  Limitation: Inter-observer variability
was not noted

14. FAST: Strengths and Limitations
Strengths Limitations
 Rapid (~2 mins)  Does not typically identify
 Portable source of bleeding, or detect
 Inexpensive injuries that do not cause
hemoperitoneum
 Technically simple, easy to  Requires extensive training
train (studies show to assess parenchyma
competence can be achieved reliably
after ~30 studies)
 Limited in detecting <250 cc
 Can be performed serially intraperitoneal fluid
 Useful for guiding triage  Particularly poor at detecting
decisions in trauma patients bowel and mesentery
damage (44% sensitivity)
 Difficult to assess
retroperitoneum
 Limited by habitus in obese
patients

15. Conclusion
 FAST scan performed by EN who are
trained in short course of ultrasonography
can be reliable and accurate when
comparable to qualified radiologist.
 It can be helpful during crisis scenarios
e.g. Mass casualty incidents.