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Fast Ultrasound: Focused Assessment with Sonography in Trauma

Fast Ultrasound usually refers to the assessment of abdominopelvic viscera’s for injury and body cavities for fluid in case of trauma.

Technique of Fast Ultrasound:

  • Fast Ultrasound is performed in emergency situations.
  • Fast Ultrasound is performed by Ultrasound machine using 3.5MHz and 5.0MHz probes.
  • The patient should lie in the supine position. Also, examine in lateral decubitus position.
  • Apply a moderate amount of gel for comfortable use of the probe.
  • Following areas should be examined carefully
  1. Perihepatic
  2. Perisplenic
  3. Pelvic
  4. Pericardium
  5. Pleural cavities.
Fast Ultrasound Location of probe placement
Location of probe placement
  • First, examine right hypochondrium region. Place the probe in longitudinal view and assess right lobe of liver and right kidney for any injury. Look for any fluid in Morrison’s pouch. Also, assess right pleural cavity.
Fast Ultrasound Right Hypochondrium
Right Hypochondrium
  • Now examine the left hypochondrium region. Place the probe in longitudinal view and look for any injury to the spleen and left kidney and for fluid in this region. Also, assess left the pleural cavity.
Fast Ultrasound Left Hypochondrium
Left Hypochondrium
  • Examine epigastric region. Put the probe in transverse view below xiphoid process slightly turning the probe upwards. Look for any fluid in the pericardial cavity. Also look for any left lobe liver injury.
Fast Ultrasound Pericardium Transverse View
Pericardium Transverse View
  • Examine suprapubic region. Place the probe first in transverse view than in longitudinal view. Look for any fluid in the pouch of Douglas and also for bladder injury.
Fast Ultrasound Pelvis, Longitudinal View
Pelvis, Longitudinal View

Indications:

  • To assess visceral trauma in blunt abdominal trauma and stable penetrating trauma.
  • To evaluate fluid in peritoneal, pericardial and pleural cavities.

Contraindications:

  • If homeostasis is to be maintained, it should be given priority over Fast Ultrasound.
  • If resuscitation is to be done, Fast Ultrasound should be delayed.

Benefits:

  • Fast Ultrasound is less time taking.
  • It is less expensive as compared to CT.
  • It is non-invasive technique.
  • It is safe for pregnant ladies and children.
  • It helps in diagnosing haemoperitoneum.
  • It takes less time in diagnosing the visceral injury.

Disadvantages:

  • Fast Ultrasound cannot assess retroperitoneal injuries.
  • It requires atleast 200cc fluid for detection.
  • It is difficult to perform on obese patients.
  • It cannot differentiate ascites and urine from the blood.

Extended FAST scan or E-FAST scan is modified version of Fast Ultrasound.

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