FAST Exam
Fast is fine, but accuracy is everything - Wyatt Earp
.jpg)
image by: រៀនអេកូ-Learn Ultrasound
HWN Suggests
The upper quadrants of the FAST scan #FOAMed
The focused assessment with sonography in trauma, or FAST exam, is undoubtedly the most widely used bedside ultrasound application in emergency medicine. With its incorporation into the ATLS trauma protocol, the FAST exam is performed immediately after the primary survey simultaneously with other resuscitative efforts. It is also a component of the RUSH protocol for patients with unexplained shock. Trauma patients often present with multiple injuries, and significant bleeding can occur without obvious changes in vitals signs. Medical patients can present intoxicated, altered, delirious, or demented all of which will limit the physical exam.
The primary purpose of the FAST exam is to…
Resources
EFAST Exam
Basically because no one else was doing it. Mike and I both really wanted to listen to a well done ultrasound podcast similar to the podcasts out there such as EMRAP, EMcrit, and ERCAST. However, it wasn’t out there, so after our Fellowship training (University of Utah) we decided to do it ourselves.
eFAST
The objective of the extended focused assessment for sonography in trauma (eFAST) is to detect free fluid in the peritoneal, pleural and pericardial spaces, and also to detect free air in thoracic cavities. In the setting of trauma, we assume this fluid is blood; however, it can be urine or bowel contents as a result of organ rupture or it can be pre-existing ascites. An eFAST exam should take less than 5 minutes to complete.
Boring Question: What is the role of the FAST exam for blunt abdominal trauma?
The usefulness of the FAST exam is in primarily in ruling in intra-abdominal injury; its specificity in the hands of emergency physicians in this setting has been proven.
Don’t Half-Ass your FAST!
I've wanted to discuss tips and pitfalls for the FAST exam for a while now, but I needed a master to talk with. Luckily at Castlefest, I met Laleh Gharahbaghian, MD. She is the Ultrasound Director at Stanford's Dept. of Emergency Medicine as well as being too cool for school. She is also FOAMY with what I think is the best blog on all things point-of-care ultrasound: sonospot.com.
Focused Assessment with Sonography for Trauma
Ultrasound has revolutionized the care of traumatic injuries. Numerous studies, albeit mostly observational, have demonstrated that the eFAST protocol is a clinically significant adjunct in the evaluation and treatment of trauma patients.
Limitations to the FAST exam
• Though the quantity of free intraperitoneal fluid that can be accurately detected on ultrasound has been reported as little as 100mL, the typical cut-off is around 500-600mL; smaller amounts of free fluid may be missed (one reason why a repeated exam can be helpful) • Can’t detect a viscus perforation • Can’t detect a bowel wall contusion • Can’t detect pancreatic trauma • Can’t detect renal pedicle injuries
Soundings: Fast Exam
The FAST exam is proven and useful at the bedside during resuscitation of the seriously injured patient to rapidly evaluate the peritoneal, pleural and pericardial spaces for bleeding. Multiple planes should be scanned in each area to improve sensitivity and specificity. Delayed imaging or the use of the Trendelenberg position may improve sensitivity.
The upper quadrants of the FAST scan #FOAMed
The focused assessment with sonography in trauma, or FAST exam, is undoubtedly the most widely used bedside ultrasound application in emergency medicine. With its incorporation into the ATLS trauma protocol, the FAST exam is performed immediately after the primary survey simultaneously with other resuscitative efforts
Taming the SRU
Blunt Abdominal Trauma: This is the primary and historical indication for FAST. 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. This has now essentially replaced the role of DPL in evaluation of the trauma patient. FAST can also be used in the stable patient although it is of less predictive utility in assessing need for surgical intervention.
EM Curious
EMCurious is a unique blend of high yield learning resources designed for emergency medicine residents and curious medical students.
Ultrasound Idiots
In its current state, the EFAST is a point-of-care ultrasound protocol for critically ill trauma patients. With experience, healthcare providers can quickly and accurately identify pathology in the peritoneal, pericardial, and pleural spaces.
SonoSpot: Topics in Bedside Ultrasound
Share & highlight US cases, tips & tricks, research, news, people and events.
SonoAccess
We believe the best chance a patient has at getting better is a clinician at their beside with the right answers and the confidence to act. That's why we created SonoAccess, our no-cost ultrasound app that can get you from "zero to scan" with confidence. When you download SonoAccess, you'll get a first-class ultrasound app with extensive clinical education content, product guides, How-To videos, clinical images, and reference guides for point-of-care ultrasound.
SonoDoc
A bedside ultrasound game.
Sonoguide
Welcome to sonoguide! sonoguide was developed by members of the American College of Emergency Physicians (ACEP) Emergency Ultrasound Section as a result of a Section Grant. Created to educate at the undergraduate level, the project became a sophisticated and comprehensive reference with state-of-the-art graphics that serves any level of medical training and continuing medical education.
SonoSim
SonoSim develops and markets state-of-the-art simulation training products for physicians, nurses, students and careproviders who need to continually expand and improve their ultrasound skills. The company comprises leading ultrasound educators, computer-based instructional designers, content editors, computer engineers and scientists, and software developers.
Sonosite
Sonosite has long recognized the very specific needs of emergency physicians, and we offer products that are uniquely suited to provide full diagnostic capabilities at the bedside. Fast, high-quality imaging at the point of care saves lives, increases patient safety, and improves clinician efficiency.
Core Ultrasound
Basically because no one else was doing it. Mike and I both really wanted to listen to a well done ultrasound podcast similar to the podcasts out there such as EMRAP, EMcrit, and ERCAST. However, it wasn’t out there, so after our Fellowship training (University of Utah) we decided to do it ourselves.
EmergencyUltrasound.com
We have assembled a staff of experienced emergency physicians from some of the busiest academic emergency departments in the country to provide ultrasound education to practicing emergency physicians with an interest in expanding their clinical horizon. We offer multiple courses at attractive locations, or we can come to your location and help instruct your entire staff.
Introduction to Bedside Ultrasound
Emergency medicine ultrasound combines three traditionally distinct parts: obtaining the relevant ultrasound images, interpreting the images obtained, and applying this information to patient care. By combining these parts which were traditionally done by the US technician, the radiologist and the EM physician respectively, the EM physician can speed the care and disposition of patients in the Emergency Department.
WikEM
Negative exam does not rule out intraabdominal injuries...

Introducing Stitches!
Your Path to Meaningful Connections in the World of Health and Medicine
Connect, Collaborate, and Engage!
Coming Soon - Stitches, the innovative chat app from the creators of HWN. Join meaningful conversations on health and medical topics. Share text, images, and videos seamlessly. Connect directly within HWN's topic pages and articles.