FAST

Introduction:

The Focused Assessment with Sonography in Trauma (FAST) has been used by emergency physicians and surgeons for decades to diagnose hemoperitoneum and hemopericardium at the bedside. Many studies have demonstrated a good positive predictive value for the test in the setting of blunt torso trauma.

Focused Questions:

1. Is there fluid in the peritoneal cavity (ie. hemoperitoneum)?

2. Is there a pericardial effusion?

3. Is there fluid in the thorax (ie. hemothorax)?

4. Is there a pneumothorax? (see separate pneumothorax tutorial)

Required Views:

Video Overview:

Required Views:

1. Right Upper Quadrant (Morison’s Pouch)

Probe position Image
PRobe position for right upper quadrant view Right Upper Quadrant- normal ultrasound
Notes
  • Be sure to visualize the diaphragm, the interface between the liver and kidney, and the inferior pole of the kidney
  • Check above the diaphragm for signs of free fluid in the right hemithorax
Abnormal Studies (click to enlarge)
RUQ1RUQ2RUQ3RUQ4

2. Left Upper Quadrant (Perisplenic space)

Probe position Image
Probe position for Left Upper Quadrant view LUQ- normal
Notes
  • Be sure to visualize the diaphragm, and the entire spleen
  • Check above the diaphragm for signs of free fluid in the left hemithorax
Abnormal Studies (click to enlarge)
LUQ1

3. Rectovesicular space (Pelvic cul-de-sac)

Probe position Image
Probe position for pelvis US pelvic cul-de-sac- normal
Notes
  • Be sure to visualize the most dependent portion of the bladder, at the interface with the rectum, and prostate or uterus
  • May also be viewed in a longitudinal plane
Abnormal Studies (click to enlarge)
Blad1Blad2

4. Pericardium

Probe position Image
Probe position for subxiphoid cardiac view US subxiphoid- normal
Notes
  • Both the anterior and posterior pericardium should be visualized
  • Parasternal views (see cardiac tutorial) should be attempted if the subxiphoid view is not adequate
Abnormal Studies (click to enlarge)
Subx2