FAST scan (Focused Assessment with Sonography for Trauma) Source: http://www.trauma.org/archive/radiology/FASTintro.

html o Allows timely diagnosis of life threatening hemorrhage and help to determine the need for transfer to OT, for CT scan, angiogram. o Indication: o Trauma patients with abdominal trauma, are hypotensive or unable to provide reliable history because of impaired consciousness d/t head injury/drugs. o Examine four areas: o Perihepatic & hepatorenal space o Perisplenic o Pelvis o Pericardium o How to perform: o Perihepatic scan (hepatorenal space most dependent part of upper peritoneal cavity and intraperitoneal fluid collects in this area first) Probe placed in right mid to posterior axillary line at the level of 11th and 12th ribs. Blood shown as hypoechoic black stripe between capsule and fatty fascia of the kidney.

o Perisplenic scan o Transducer placed on left posterior axillary line region between 10th an 11th ribs.

o Pelvic scan o Visualizes the cul-de-sac/pouch of Douglas in females and rectovesical pouch in male most dependent portion of lower abdomen and pelvis o Transducer placed midline just superior to symphysis pubis

o Pericardium scan

o Visualizes fluid between fibrous pericardium and heart o Transducer placed just left of the xiphisternum and angle upwards under costal margin

o Management:

*DPL: diagnostic peritoneal lavage

o If FAST is positive: Thoracic hemorrhage thoracotomy Pelvic hemorrhage angiographic embolization Intraperitoneal fluid/hemorrhage laparotomy o If FAST is negative consider other sites of loss and perform serial FAST scan Possible false negative of FAST (when carried out in early phase where only small amt of fluid visible) o Indeterminate FAST scan (especially obese/subcut emphysema) Decision depends on mechanism of injury and pattern, clinical signs

o How good is FAST: o Sensitivity of 100% and specificity of 96% for identifying need for laparotomy in hypotensive patients o Not so good in predicting solid organ injuries