DISKUSI TOPIK Focussed

Assesment Sonography in Trauma

ADITYA ISLAMI
I1112009
KEPANITERAAN KLINIK RADIOLOGI RS UNTAN

Introduction
The FAST scan is a 4 view scan reliant on detecting the
presence of fluid within the pericardium and most
dependent zones of the peritoneum in the horizontal
patient.
Relies on the principle that in the supine patient, free fluid
(FF) such as blood collects in certain anatomical sites
FAST scanning is indicated in any patient who has
sustained
blunt
abdominal
trauma,
whether
haemodynamically unstable or not.
ATLS principles the FAST scan is used as an adjunct to
the primary survey assessment of circulation
Capable of detecting more than 100-250ml of free fluid
The sensitivity of the FAST scan has been quoted as 78%
with a specificity of 99% in the evaluation of
intraabdominal injuries.
FAST is performed using abdominal probe with frequency
3.5 - 5.0 MHz.

patients position
The patient should be in the supine
position with arms abducted slightly or
above the head to allow visualization of
Morisons pouch and the spleen.
Alternatively the patient may be asked to
fold their arms across their chest.
This maneuver will be determined by
consciousness level of the patient and the
presence of any upper extremity injury.

FAST views
1. subxiphoid/subcostal view
2. right upper quadrant view
3. left upper quadrant view
4. pelvic view: transverse and
sagittal

subxiphoid/sub
costal view

The probe is laid almost flat

on the patients epigastrium
and angle towards the
head.

The
heart
will
be
surrounded by a rim of
echogenic pericardium.

Any
discrete
blackness
between this rim and the
heart wall represents fluid
in the pericardial sac.
Pericardial fluid appears as
a black stripe.

right upper
quadrant view

Morisons pouch and

lung base

right

Morrison's pouch represents

the potential space between
the capsule of the liver and
the
fascia
around
the
kidney.

Probe parallel and between

the 11th and 12th ribs with
the beam in a cranio caudal
plane the liver, kidney
and diaphragm should be
demonstrated.

FF will appear as a black

stripe in Morisons pouch.

left upper
quadrant view

The transducer is positioned

between the 10th and 11th
ribs and more posteriorly, in
the posterior axillary line.
with the ultrasound beam in
a cranio caudal plane
demonstrates the spleen,
kidney and diaphragm.

FF will appear as a black

stripe in the lienorenal
interface or between the
spleen and the diaphragm
(subphrenic FF).

Any evidence of a black rim

between the 2 organs
represents
free
intraperitoneal fluid.

Free fluid

suprapubic
view

It is important that the

patient have a full bladder
during this part of the
examination.

To observe transverse and

sagittal pelvic view.

Transverse pelvic view:

The transducer is placed
transversely
in
the
abdominal
midline
approximately
4
cm
superior to the symphysis
pubis
and
angled
downwards in to the pelvis
demonstrates the bladder

Normal transverse
pelvic view

Free fluid
(arrowed)

suprapubic
view
Sagittal pelvic view:

Probe placed in the midline

just above the pubis and
angled caudally at 45
degrees into the pelvis
demonstrates
a
sagittal
section of the bladder and
pelvic organs

FF will be around the

bladder or behind it (Pouch
of Douglas).

Bladder

Rectum

Uterus
Pouch of
Douglas

What FAST Can Tell You

FAST can determine the presence of the
following:
Free intraperitoneal fluid
Pericardial fluid
Pleural fluid

What FAST Cannot Tell You

FAST cannot determine the following:

Source of free fluid

Nature of free fluid eg. blood versus ascites
Presence of solid organ or hollow viscus injury
Presence of retroperitoneal injury

False negative scans: in the presence of small

amounts of FF in a single view of Morisons
pouch or lienorenal interface

False positives scans: due to fluid filled

structures such as inferior vena cava,
gallbladder and intraluminal bowel fluid.
Other causes of false positive scans include:

Fat eg. pericardial fat pad

Ascites
Mirror artifact

cautions and
contraindications
Absolute contraindications: the presence of a more
pressing problem (such as airway obstruction) or a clear
indication for emergency laparotomy (in which case FAST is
not indicated)
Indicated only if it will affect patient management. Eg:
stable patient with blunt abdominal trauma, a negative
FAST gives no information about solid organs or hollow
viscus injury CT and/or small bowel series.
Children: FAST can be performed, but CT scanning remains the
investigation of choice in paediatric abdominal trauma. The
threshold for operative intervention in paediatric blunt abdominal
trauma is higher than for adults.
Timing: A very early scan may be falsely negative as sufficient
intra-abdominal blood may not have collected in the dependent
areas. Furthermore, occasionally a late scan may be falsely
negative as clotted blood is of similar echogenicity to liver and
may not be easily identified in Morisons pouch.
Operator: the accuracy of FAST is operator-dependent and the
inexperienced scanner should be particularly wary of ruling out FF.

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