Focused Assessment with Sonography in Trauma (FAST) UC Irvine School of Medicine

Focused Assessment with Sonography in Trauma (FAST) UC Irvine School of Medicine

Purpose of FAST exam Quickly evaluate patient s status in emergency situations Blunt or penetrating trauma Visualize fluid (internal bleeding) in certain spaces inside the body FAST is fast: ~ 5 minutes

Probe and setting Convex probe Can also use phased array Use abdominal setting

Spaces where fluid can collect Look for fluid in 5 spaces or pouches Hepatorenal recess AKA Morrison s Pouch Splenorenal recess Pericardial sac Pelvic region Pleural cavity (right and left sides)

Terms Pleural effusion = fluid in pleural (chest) cavity surrounding the lungs Hemothorax = blood in pleural cavity Hemoperitoneum = blood in peritoneal (abdominal) cavity Between liver and kidney on the right side Between spleen and kidney on the left side Pericardial effusion = fluid in the pericardial sac surrounding the heart

FAST Windows 1. 2. b. a. 3. 4.

Probe in coronal position

Things to look for in RUQ 1.Loss of mirror image artifact across diaphragm -Mirror image artifact = Normal -Black = pleural effusion (ex. Hemothorax) 2. Hepatorenal Recess Morrison s pouch. Hemoperitoneum = fluid in abdominal cavity Most common place for fluid to accumulate in supine patient Mirror Image Artifact

Normal patient head feet Mirror image

Pleural effusion (fluid in chest cavity) Liver Kidney Fluid Diaphragm

(Normal)

Hepatorenal Recess - Morrison s Pouch Potential space visible only if there s fluid Kidney Diaphragm Liver Probe should still be in coronal orientation. Indicator is to the head Fan (angle) probe posteriorly to see kidney.

Fluid in Morrison s Pouch Normal Fluid in Morrison s Pouch

Question: Q: What orientation should the probe be in when examining the right upper quadrant? A: Coronal

Cardiac: Subxiphoid To see fluid around the heart: pericardial effusion In a transverse view start at the liver and scan medially FAST SCAN ONLY: indicator to the right because using abdominal setting Right atrium and right ventricle are seen on the top of the scan

Pericardial Sac Fluid in Pericardial sac = Pericardial Effusion Pericadial Sac appears hyperechoic on Ultrasound

Normal Subxiphoid View Pericardium will be seen as a bright hyperechoic structure closely surrounding heart No black seen between the heart and the pericardium

Pericardial Effusion Normal pericardium pericardium

Which view shows a pericardial effusion? Normal Pericardial Effusion

Things to look for in LUQ 1. Loss of mirror image artifact across diaphragm -Black = pleural effusion (ex. Hemothorax), abnormal -Mirror image = normal 2. Fluid between spleen and kidney splenorenal recess. Hemoperitoneum = fluid in abdominal cavity

Left Upper Quadrant spleen liver kidneys -Probe in coronal orientation indicator to patient s head. -Splenorenal recess more superior and posterior than hepatorenal recess

Spleen Spleen has similar texture as the liver Q: What is the arrow pointing to? A: Diaphragm Q: Does this patient have pleural effusion? A: No. We can see the mirror image artifact Normal

` Splenorenal Recess Mirror Image Artifact Spleen Kidney Diaphragm Normal

Fluid in splenorenal recess Spleen Kidney

Fluid in the chest and abdominal cavities

Suprapubic Female Vesico-uterine pouch Recto-uterine pouch (of Douglas) Male Recto-vesicular pouch

Scan to see the entire bladder 1. Sagittal Indicator toward patient s head 2. Transverse Indicator toward patient s right. Fan inferiorly

Suprapubic - Sagittal, male Normal

Sagittal, Male Where is the free fluid?

Suprapubic - Sagittal, Female Empty Bladder Recto-uterine Pouch of Douglas Bladder Uterus Normal

Suprapubic - Sagittal, Female Full Bladder rectum

Sagittal, female Free fluid surrounding uterus

Suprapubic Transverse View Male Normal Free Fluid

Suprapubic Transverse Female Fluid Bladder

Which quadrant of the FAST Scan is this image from? Hepatorenal recess (Morrison s Pouch) Pleural cavity Probe in coronal orientation

Summary 4 windows to examine in FAST exam Right Upper Quadrant Coronal Cardiac (subxiphoid) Transverse Left Upper Quadrant Coronal Pelvic Sagittal and transverse

Summary Look for fluid In pleural cavity (loss of mirror image of liver and spleen) Hepatorenal recess (Morrison s pouch) Pericardial Sac Splenorenal recess Recto-vesical pouch (male) Recto-uterine pouch of Douglas, Vesico-uterine pouch (female)

References Atlas of Anatomy, Second Edition, By Gilroy, MacPherson, Ross, Schuenke, Schulte, Schumacher. Thieme Medical Publishers, 2012. Select images from the UCISOM Ultrasound in Education Department