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INTRODUCTION

Evaluation of blunt trauma patients with ultrasound (US) has been described for over 30 years.1-3 Its use in the United States in the early assessment of blunt abdominal trauma patients rapidly increased in the 1990s.1 It is currently taught as an adjunct to the secondary survey in the Advanced Trauma Life Support (ATLS) course and in residencies.1,4 US evaluation of the trauma patient decreases the costs in blunt trauma patients, resource utilization, and time to operative care.5,6 There are many advantages to US (Table 8-1).7 The focused assessment with sonography in trauma examination is known as the FAST examination and can be completed within 5 minutes.1 It has replaced the need for a diagnostic peritoneal lavage (Chapter 84) in the initial assessment of all but a few trauma patients.8,9 This chapter reviews the technique and interpretation of the FAST examination and the extended FAST, or EFAST, examination.

TABLE 8-1Advantages of Using US

ANATOMY AND PATHOPHYSIOLOGY

The FAST examination evaluates four anatomic areas or potential spaces for the presence or absence of fluid. These include the hepatorenal recess or Morrison’s pouch, the splenorenal recess, the rectovesical or rectouterine space, and the pericardial space. It assumes fluid present represents blood in the setting of trauma. The presence of ascites, bowel fluid, and urine can appear similar using US. These four spaces represent the most dependent areas in the supine patient (Figure 8-1). The volume of fluid accumulation required for visualization by US ranges from 250 to 620 mL.10,11 More experienced sonographers can visualize volumes closer to 250 mL.10

FIGURE 8-1.

The posterior reflection of the peritoneum is where blood initially layers in the supine patient. The hepatorenal (A) and splenorenal (B) recesses represent the posterior peritoneal reflections between the inferior pole of the kidney and the liver or spleen, respectively.

INDICATIONS

The FAST examination is performed after the primary survey. It can be performed in conjunction with ongoing resuscitative efforts. It is ...

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