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Focused Assessment with Sonography in Trauma (FAST) Exam

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A Practical Guide to Point of Care Ultrasound (POCUS)

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Abstract

The Focused Assessment with Sonography in Trauma (FAST) exam is performed to identify the presence of pathological fluid in the chest, abdomen, or pelvis of the trauma patient with blunt or penetrating injury to the torso. The FAST exam can be performed by any member of a trauma team during prehospital or in-hospital assessment. Paramedics, doctors in training, nurses and specialists in emergency medicine, critical care, and anesthesia can perform the FAST exam. This chapter aims to impart the necessary knowledge and skills required for clinicians to optimally and safely perform a FAST exam. This chapter describes the principles and techniques of the FAST exam, the various views obtained, and interpretation the images obtained. It also discusses tips on troubleshooting commonly encountered problems while performing the FAST exam. The basics of the FAST exam have been explicitly described for the new learner, laying a strong foundation for continued learning and progression into an advanced practitioner.

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Author information

Authors and Affiliations

  1. Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Vishakha Prasad Erasu & Priyadarshini Marathe

  2. Emergency Medicine Research in Oxford, Oxford, UK

    Vishakha Prasad Erasu

Authors
  1. Vishakha Prasad Erasu
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  2. Priyadarshini Marathe
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Corresponding author

Correspondence to Vishakha Prasad Erasu .

Editor information

Editors and Affiliations

  1. Department of Anaesthesia, Critical Care and Pain, Tata Medical Center, Newtown, Kolkata, West Bengal, India

    Arunangshu Chakraborty

  2. Department of Anaesthesia, National University Hospital, Singapore, Singapore

    Balakrishnan Ashokka

Self-Assessment Questions: Chose the Single Best Answer

Self-Assessment Questions: Chose the Single Best Answer

  1. 1.

    The FAST scan includes all of the following views EXCEPT:

    1. A.

      Right upper quadrant

    2. B.

      Left upper quadrant

    3. C.

      Pelvic

    4. D.

      Longitudinal view of the aorta

  2. 2.

    You are going to begin your FAST scan with the abdominal exam. The probe that can be used for this exam is:

    1. A.

      The curvilinear probe with abdominal/FAST preset

    2. B.

      The cardiac probe with abdominal preset

    3. C.

      Both of the above

    4. D.

      Only the linear probe

  3. 3.

    You are going to perform the extended FAST scan. Which probe is best suited for visualizing the pleura and why?

    1. A.

      Linear probe because of its high frequency

    2. B.

      Linear probe because of its low frequency

    3. C.

      Phased array probe because of its low frequency

    4. D.

      None of the above

  4. 4.

    The Morison’s pouch is the most dependent area in the abdomen of the supine patient. This lies between the:

    1. A.

      Spleen and left kidney

    2. B.

      Liver and right kidney

    3. C.

      Urinary bladder and rectum

    4. D.

      Urinary bladder and uterus

  5. 5.

    All of the following are expected to be visualized on the left upper quadrant view EXCEPT:

    1. A.

      Heart

    2. B.

      Diaphragm

    3. C.

      Spleen

    4. D.

      Left kidney

  6. 6.

    The FAST exam on a hemodynamically unstable young gentleman involved in a significant motor vehicle collision is positive. What would be the next step in the management of this patient (ATLS management ongoing)

    1. A.

      DPL to check if the fluid in the abdomen is blood

    2. B.

      Observe and repeat FAST scan when patient becomes stable

    3. C.

      CT scan if stabilizes by resuscitation, else emergency exploratory laparotomy in theatre

    4. D.

      Repeat FAST scan every 5 min till the patient is stable

  7. 7.

    The FAST exam on a hemodynamically stable young lady who fell down a flight of stairs after a few drinks is negative. She is tender in the abdomen and confused. What would be the most appropriate next step in the management of this patient?

    1. A.

      Repeat a FAST scan if clinical picture changes

    2. B.

      Pan CT to exclude injuries from head to pelvis

    3. C.

      Discharge home to sober up

    4. D.

      Get a radiologist to perform a bedside abdominal ultrasound

  8. 8.

    The following non-trauma patients benefit from having a FAST/FAFF scan:

    1. A.

      Suspected ruptured ectopic pregnancy

    2. B.

      Medical patient with unexplained hypotension

    3. C.

      Both

    4. D.

      None

  9. 9.

    The following are normal findings while performing an extended FAST scan EXCEPT:

    1. A.

      A-lines

    2. B.

      Occasional B-lines

    3. C.

      Lung Sliding

    4. D.

      Lung point

  10. 10.

    The full bladder can enhance structures situated posterior to it and make them appear hyperechoic. The adjustment that can help to make the image better is:

    1. A.

      Increase depth

    2. B.

      Time-gain-compensation

    3. C.

      Increase gain

    4. D.

      All of the above

  11. 11.

    Physiological fluid is commonly found in the following space in the FAST scan:

    1. A.

      Hepatorenal recess

    2. B.

      Splenorenal recess

    3. C.

      Pelvis of the female patient

    4. D.

      Pleural spaces

  12. 12.

    The next step when unable to obtain a subcostal view of the pericardium is to:

    1. A.

      Press harder while pointing to the right shoulder

    2. B.

      Obtain the parasternal long-axis view

    3. C.

      Proceed with other views of the FAST scan

    4. D.

      Perform a transthoracic echocardiography

  13. 13.

    The direction of the probe when obtaining the subcostal view is pointing towards the:

    1. A.

      Left shoulder

    2. B.

      Right shoulder

    3. C.

      Suprasternal notch

    4. D.

      Umbilicus

  14. 14.

    The depth setting for obtaining the subcostal view is:

    1. A.

      2 cm

    2. B.

      5 cm

    3. C.

      10 cm

    4. D.

      20 cm

  15. 15.

    While performing the extended FAST exam, the sign that signifies the presence of a pneumothorax in the M-mode is called:

    1. A.

      Seashore/Sandy beach sign

    2. B.

      Barcode/Stratosphere sign

    3. C.

      Trampoline sign

    4. D.

      Fishtail sign

  16. 16.

    The FAST exam should be performed:

    1. A.

      To look for pathological fluid in the unstable trauma patient

    2. B.

      To rule out any abdominal pathology in the trauma patient

    3. C.

      In every trauma patient irrespective of hemodynamic status and injury

    4. D.

      By the senior-most clinician available

  17. 17.

    Signs of Cardiac Tamponade are:

    1. A.

      Large pericardial effusion

    2. B.

      Right ventricular (RV) collapse in diastole

    3. C.

      Right atrial (RA) collapse in systole

    4. D.

      All of the above

  18. 18.

    The presence of fluid in the thorax, e.g., Hemothorax on a FAST scan is seen as:

    1. A.

      Anechoic shadow above the diaphragm

    2. B.

      Vertebral bodies become visible above the diaphragm (Spine sign)

    3. C.

      Collapsed lung dances in the fluid (Whale tail or Jellyfish sign)

    4. D.

      All of the above

  19. 19.

    A posterior pericardial effusion in the PLAX view is located:

    1. A.

      Anterior to the descending aorta

    2. B.

      Posterior to the descending aorta

    3. C.

      Anterior to the IVC

    4. D.

      Posterior to the IVC

  20. 20.

    Your colleague performed a FAST scan in a stable trauma patient that was negative, after which the patient went on to have a CT scan that showed small lacerations of the right kidney and right lobe of the liver with minimal intra-abdominal fluid. Your colleague feels upset that they recorded a negative FAST exam. What advice will you give your colleague?

    1. A.

      Advise them that they need more practice in FAST scans as their FAST report was incorrect

    2. B.

      Advise them that the FAST exam has low sensitivity in detecting small amounts of fluid and the fluid may have started collecting after the FAST was done, so the FAST they did was valid for that time

    3. C.

      Advise them to get a second opinion on the CT report as it cannot be correct

    4. D.

      Advise them to arrange for an exploratory laparotomy

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Erasu, V.P., Marathe, P. (2022). Focused Assessment with Sonography in Trauma (FAST) Exam. In: Chakraborty, A., Ashokka, B. (eds) A Practical Guide to Point of Care Ultrasound (POCUS). Springer, Singapore. https://doi.org/10.1007/978-981-16-7687-1_7

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  • DOI: https://doi.org/10.1007/978-981-16-7687-1_7

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-16-7686-4

  • Online ISBN: 978-981-16-7687-1

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