The left portion of the screen will correspond to the thorax, and the right to the abdomen. To extend intrathoracic portion of view for eFAST, slide the probe cephalad to again visualize diaphragm, now keeping the diaphragmatic line towards the center of the screen. A positive scan would appear as a dark stripe of fluid between the liver and kidney This may require fanning at multiple levels in order to obtain a complete image.
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Orient the probe in the longitudinal plane with the indicator facing towards the patient's head.Ĭhoose an area between the 8-11th intercostal space in the mid axillary line to begin scanning.Īttempt to first obtain a view of the liver with diaphragmatic line visible towards the left of the screen, then slowly adjust by sliding or angling the probe caudad until the right kidney comes into view.įan anterior to posterior to obtain a complete view of Morisons pouch, taking care to visualize interface of the inferior tip of the liver and lower pole of the kidney as this is the most sensitive location for free fluid in this view. This is due to position of the splenocolic ligament, which can block blood from travelling down the left paracolic gutter, as well as tendency for bleeding in the LUQ to originate from the splenic vasculature in blunt trauma. Fluid in the LUQ more commonly tends to collect between the spleen and the diaphragm, as opposed to collecting in the splenorenal recess. Importantly, while fluid can collect in the subdiaphragmatic area in the RUQ, this is more common in the LUQ. This area is identified by the hyperechoic diaphragmatic line, and the mixed echogenicity of the spleen and kidney, also separated by the hyperechoic fascial line. Splenorenal recess: Located in the LUQ between the spleen and Gerota’s fascia of the kidney As such, it should always be included in the FAST examination for it to be considered adequate. It has been shown that this view can detect as little as 200 mL of free fluid in the abdomen. This is generally the most dependent area in the abdomen, and thus the most sensitive location for assessing free fluid. In a normal patient, this interface should appear as a hyperechoic line (representing the abutting fascia layers)Īlso visible in the RUQ is the right superior paracolic gutter. This is often described as an area adjacent to the inferior edge of the liver. Morisons Pouch or Hepatorenal recess: Located in the RUQ between the capsule of the liver and Gerota’s fascia of the kidney The FAST focuses on these as areas of evaluation. These gutters flow towards potential spaces (described below) in the abdomen. Notably, the right paracolic gutter is deeper and less obstructed than the left, as such, fluid generally tends to flow towards the right paracolic gutter. Keep in mind, individual institutional algorithms may vary.Īn example of a standard algorithm when FAST was first adopted: In select circumstances, DPL can still be valuable in evaluating fluid (such as ascites) vs. FAST can also be used in the stable patient although it is of less predictive utility in assessing need for surgical intervention. This has now essentially replaced the role of DPL in evaluation of the trauma patient.
In cases of blunt abdominal trauma, FAST is used to determine the presence of intraperitoneal hemorrhage in unstable patient, thus determining need for emergent laparotomy. INDICATIONSīlunt Abdominal Trauma: This is the primary and historical indication for FAST. The eFAST exam also includes lung evaluation to assess for pneumothorax. TL DR? Click for Minimum Diagnostic image requirements Objective:ĭetection of intraperitoneal, intrathoracic or pericardial blood in the setting of trauma. ( Focused Assessment with Sonography for Trauma)
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