Focused assessment free#
The RUQ view is the most likely to detect free fluid with an overall sensitivity of 66%. Start with your hand against the bed to ensure visualization of the retroperitoneal kidney. Position the probe in the sagittal orientation along the patient’s flank at the level of the 8 to 11 rib spaces. The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe. The FAST exam evaluates the pericardium and three potential spaces within the peritoneal cavity for pathologic fluid. The eFAST examines each hemithorax for the presence of hemothoraces and pneumothoraces. Recently, many institutions have introduced the Extended FAST (eFAST) protocol into their trauma algorithms. Presently, more than 96% of level 1 trauma centers incorporate FAST into their trauma algorithms as does Advanced Trauma Life Support (ATLS). Experienced providers perform the FAST exam in less than 5 minutes, and its use decreases time to surgical intervention, patient length of stay, and rates of CT and DPL.
In the subset of hypotensive trauma patients, the sensitivity of the FAST exam approaches 100%. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%. The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. However, widespread adoption in the United States did not occur until the 1990s. Furthermore, it is non-invasive, employs no radiation or contrast agents, and is inexpensive. The use of ultrasound to detect intraperitoneal fluid was first described in Europe during the 1970s. Ultrasound has considerable advantages, including its bedside availability, ease of use, and reproducibility. The implementation of point of care ultrasound has significantly impacted the evaluation and treatment of patients. However, time delays and transportation out of the emergency department confound the evaluation of hemodynamically unstable patients.
CT remains the gold standard for diagnosing intra-abdominal injuries detecting as little as 100 cc of intraperitoneal fluid. While extremely sensitive (96% to 99%) and specific (98%), DPL is an invasive procedure with a complication rate of 1%,. Historically, providers performed diagnostic peritoneal lavage (DPL) to detect hemoperitoneum. The optimal test should be rapid, accurate, and non-invasive. In fact, intraperitoneal bleeds occur in 12% of blunt trauma therefore, it is essential to identify trauma quickly. Eighty percent of traumatic injury is blunt with the majority of deaths secondary to hypovolemic shock. Traumatic injury is the leading cause of death among individuals younger than 45 years old.
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