The Focused Assessment with Sonography in Trauma (FAST) is a point-of-care ultrasound examination performed at the time of presentation of a trauma patient.
It is an ultrasound protocol developed to identify intraperitoneal free fluid (assumed to be hemoperitoneum in the context of trauma) allowing for an immediate transfer to theater, CT or other. Solid organ injury is seldom identified, and when present may warrant further investigation.
Now, the use of ultrasound device (US) in trauma has expanded to identifying a variety of traumatic injuries: hemoperitoneum, pneumothorax, hemothorax, hemopericardium with or without tamponade, traumatic hypovolemia, and even rib, nose, and other fractures! Clinicians who use the SIFULTRAS-5.42 seek to quickly detect free intraabdominal fluid or cardiac complications.
The extended FAST, or E-FAST, expands the examination to assess for pneumothorax. The primary indications for performing a FAST are blunt or penetrating trauma, trauma in pregnancy, or hypotension of unclear etiology.
A FAST using the portable ultrasound scanner SIFULTRAS-5.42 helps determine which patients require emergent laparotomy and which can be monitored or await slower, more definitive studies. Image courtesy of Wikimedia Commons.
The philosophy behind the FAST examination is that fluid will pool in the most dependent areas. As a result, the FAST examination includes 3 views that can detect pooled blood (red lines) and one to evaluate the heart: the hepatorenal recess, the perisplenic view, the subxiphoid pericardial window, and the suprapubic window. Which asserts the compatibility of the FAST with the double headed wireless ultrasound scanner SIFULTRAS-5.42. Its 3.5 – 5 MHz curvilinear (or abdominal) probe is used for the eFAST exam to eliminate delays when switching between transducers.
However, the linear 7.5 – 10 MHz probe is effective as well, particularly with parasternal windows. Likewise, it is ideal for assessing for pleural sliding. The implementation of point of care ultrasound has significantly impacted the evaluation and treatment of patients. SIFULTRAS-5.42 has considerable advantages, including its bedside availability, ease of use, and reproducibility.
Furthermore, it is non-invasive, employs no radiation or contrast agents, and is inexpensive. The use of ultrasound to detect intraperitoneal fluid was first described its use decreases time to surgical intervention, patient length of stay, and rates of Computed tomography (CT) and Diagnostic peritoneal lavage (DPL).