1. Focused Abdominal Sonography for Trauma
Samuel Kingsley
Advocate Illinois Masonic Hospital

2. Abdominal Ultrasonography
An important diagnostic modality within the trauma population Originally reported in this context by German and Japanese physicians in the 1970s US implementation and publications began in the 1980s Rozycki (1995) formalized the abdominal assessment describing four windows: RUQ, LUQ, Pelvis, Pericardium Shackford (1996) introduced the acronym FAST

3. Pros & Cons Benefits: Rapid assessment Non invasive No radiation
Requires no drugs/toxins
Serial assessments
Rapid learning curve
Drawbacks:
False negative
Misses injuries not associated with large extravasation
Possible false positives
User dependent
Skills decay over time

4. Accuracy
FAST exam requires ~200cc of fluid to be positive (reports of 100cc) Sensitivity of FAST 73-88% Specificity of FAST %

5. Indications Blunt abdominal trauma Penetrating trauma
In unstable patient, can help determine source: peritoneal bleed vs. pericardial effusion vs. BCI
In stable patient, presence of fluid helps to determine need for CT imaging
Penetrating trauma
Unstable patient – no indication to perform FAST; patient should be taken immediately to OR
Stable patient – assess for automatic operative indications (stability), trajectory, evisceration, hematemsis, BPR; if negative…
A positive FAST will rule in operative intervention
a negative FAST does not rule out operative intervention (sensitivity< 50%)

6. Anatomy

7. Anatomy

8. Equipment

9. Probe Types

10. Orientation

11. Probe Types

12. Probe Types

13. Orientation

14. Sonosite M Turbo

15. Sonosite M Turbo

16. Sonosite M Turbo

17. Sonosite M Turbo

18. Sonosite M Turbo

19. Sonosite M Turbo

20. FAST Exam Technique Pelvic Right Upper Quadrant Left Upper Quadrant
Cardiac

21. FAST Exam Pelvis Curvilinear probe
Position just above pubic symphysis and aim inferior

22. Pelvic U/S
The bladder will be visualized as a large, hypoechoic sphere
Extravesicular fluid (blood) will appear as hypoechoic
layering inferior to the bladder

23. FAST Exam RUQ Curvilinear probe
Lateral most aspect of torso just superior to umbilicus
Position probe parallel to ribs (~2 o’clock) to minimize shadowing

24. RUQ Ultrasound

25. FAST Exam LUQ Curvilinear probe
Spleen is much smaller than liver - probe position is HIGHER and MORE POSTERIOR compared to RUQ
“Knuckles on the bed”; position probe parallel to rib space (~10 o’clock)

26. LUQ Ultrasound

27. FAST Exam Cardiac Curvilinear probe Place probe in subxyphoid window
The probe should be almost parallel with the patient; the orientation marker should point in the same direction as the dot on the screen; depth should be 19-23cm

28. Subxyphoid

29. IVC assessment
Once the subxyphoid view is established, the IVC can be assessed by rotating the probe 90° so the marker is pointing upwards
IVC diameter (3cm from RA) <1cm correlates with hypovolemia; >2cm correlates with euvolemia or hypervolemia
Collapse is important as well

30. IVC assessment

31. Questions?