From the Guidelines
In trauma evaluation, FAST stands for Focused Assessment with Sonography for Trauma, as defined by the most recent and highest quality study 1. This rapid bedside ultrasound examination is performed during the initial assessment of trauma patients to detect free fluid in the peritoneal, pericardial, and pleural spaces, which may indicate internal bleeding. The standard FAST exam includes four views: perihepatic (right upper quadrant), perisplenic (left upper quadrant), pelvic, and pericardial. Some key points about FAST include:
- It is a non-invasive diagnostic tool that helps clinicians quickly determine if a patient has internal hemorrhage requiring immediate surgical intervention.
- The extended version, E-FAST, also includes examination of the chest to detect pneumothorax.
- FAST is particularly valuable in unstable trauma patients where rapid decision-making is crucial, as it can be performed within minutes at the bedside without interrupting resuscitation efforts.
- While highly specific, FAST has limitations in sensitivity, especially for solid organ injuries without significant free fluid, so negative results should be interpreted cautiously in the context of the patient's clinical presentation, as noted in 1 and 1. The use of FAST in trauma evaluation is supported by multiple studies, including 1, 1, and 1, which highlight its role in triage and rapid decision-making. However, it is essential to consider the limitations of FAST, such as its relatively lower specificity compared to CT scans, as mentioned in 1 and 1. Overall, FAST is a valuable tool in trauma evaluation, and its use should be guided by the most recent and highest quality evidence, such as 1.
From the Research
Definition of FAST
- FAST stands for Focused Assessment with Sonography for Trauma, a limited ultrasound examination primarily aimed at identifying the presence of free intraperitoneal or pericardial fluid 2.
- It is a bedside ultrasound used to evaluate trauma patients, particularly those with blunt abdominal trauma, penetrating trauma, or unknown causes of instability 3.
Purpose of FAST
- The main purpose of FAST is to detect hemopericardium, hemoperitoneum, and hemopneumothorax in trauma patients 3.
- It is used to identify free fluid in the abdomen, which is usually due to hemorrhage, bowel contents, or both, and to determine the need for further evaluation or operative intervention 2.