EM · Procedural & diagnostic ED skills
Focused Assessment with Sonography in Trauma (FAST and E-FAST)
Also known as FAST · Focused Assessment with Sonography in Trauma · E-FAST · Extended FAST · Trauma ultrasound
The FAST (Focused Assessment with Sonography in Trauma): the four views (the Morrison pouch or hepatorenal recess, the splenorenal recess, the pouch of Douglas or rectovesical space, and the pericardial or subxiphoid view), the E-FAST extension (bilateral chest for pneumothorax with lung sliding and the lung point, plus the IVC for volume status), the sensitivity of 60 to 70 per cent for free fluid rising with the repeat scan, the specificity of around 95 per cent, the role in the hypotensive trauma patient (the positive FAST equals the operating theatre, not the CT), the technique with the curvilinear probe, the depth and the gain, and the pitfalls (the false positive from ascites or fat, the false negative from pelvic-only or retroperitoneal …
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8 MCQs with explanations
Target exams
Red flags
Related topics
- The primary survey (ABCDE) — the trauma assessment framework
- Major trauma resuscitation — the team-based systematic approach
- Damage control resuscitation in trauma
- Chest trauma (the immediately and potentially life-threatening injuries)
- Pneumothorax (including tension pneumothorax)
- Abdominal aortic aneurysm (ruptured and intact)
- Point-of-care ultrasound: biliary and renal (and the incidental AAA)
Meet the patient
A 34-year-old man is brought to the major trauma bay after a high-speed motor vehicle crash — intoxicated, GCS 13, BP 78/50, HR 132. The airway is secure, the chest is clear, two large-bore cannulae are in, and during the circulation assessment your probe finds a black anechoic stripe in the Morrison pouch.[1]
That single stripe is the hinge of his next ten minutes. Positive FAST plus hypotension equals the operating theatre, not the CT scanner — the sentence every ACEM candidate is expected to say first. Now hold the next patient beside him: a 26-year-old with a single stab wound above the left nipple, distended neck veins, and absent breath sounds on the left. The pericardial view is negative, but the chest view shows no lung sliding and a barcode sign. Same probe, same protocol, two different emergencies — a bleeding abdomen and a tension pneumothorax — both read off the same machine during the primary survey.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Emergency Medicine fellowship atlas.
References3Show ledgerHide ledger
- [1]Nishijima DK, Simel DL, Wisner DH, Holmes JF. Does this adult patient have a blunt intra-abdominal injury? JAMA, 2012.PMID 22496266
- [2]Stengel D, Leisterer J, Ferrada P, et al. Point-of-care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma Cochrane Database Syst Rev, 2018.PMID 30548249
- [3]Stengel D, Rademacher G, Ekkernkamp A, et al. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma Cochrane Database Syst Rev, 2015.PMID 26368505