Diskusi Topik

Focused Assessment with Sonography in

Trauma
(FAST)
Disusun oleh:
Scholastyka Febrylla

I11111012

Pembimbing:
dr. Fennie Rufini, Sp. Rad.

SMF Radiologi RS Universitas Tanjungpura

Fakultas Kedokteran Universitas Tanjungpura
Pontianak
2016

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/subcostal
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 right lung base

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.

Gross injury to solid organs

sometimes also be seen.

may

Free fluid (arrowed)

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.

THANK YOU