Ultrasound in trauma: FAST protocol

Abstract

Focused assessment with sonography for the trauma (FAST) is a targeted ultrasound examination of traumatized patients. The objective of the FAST exam is to detect free intraperitoneal, pericardial and pleural fluid (blood) in the setting of trauma. The four target areas of scanning include the right upper quadrant view (hepatorenal recess - Morrison space), left upper quadrant view (splenorenal recess - Koller space), pericardial view and pelvic view. The Extended FAST (E-FAST) includes a standardized lung scan for the purpose of detecting pneumothorax. The focused assessment with sonography for trauma (FAST) is a part of resuscitation of trauma patients recommended by international panel consensus and incorporated into the advanced trauma life support (ATLS) course. The E-FAST exam has largely replaced the peritoneal lavage as the primary method to detect free intraperitoneal fluid.The advantages of using ultrasound in trauma are numerous, the FAST protocol is simple, safe, without contraindications, does not require the transport of a patient, does not require prior preparation, can be repeated. The FAST is particularly suitable for hemodynamically unstable patients with blunt or penetrant trauma where it is important to quickly diagnose and take therapeutic measures. The diagnostic performance of the FAST depends on several factors, including clinical setting, experience of performers, body habitus of the patient, bowel gas interference and the equipment. Despite the number of limitations, the FAST still has a good sensitivity and specificity for identification of free fluid in trauma patients.

Keywords

• FAST
• E-FAST
• trauma
• ATLS