Focused Assessment with Sonography in Trauma (FAST)

Abstract

Introduction Ultrasound (US) was first used in the evaluation of trauma patients in Europe in the 1970s. The German surgery board has required certification in ultrasound skills since 1988. Since the mid-1980s in the United States, the use of ultrasound in trauma has become more widespread and has all but replaced diagnostic peritoneal lavage (DPL) in most trauma centers. The FAST exam has been included as part of the advanced trauma life support course since 1997 (1). In addition, the American College of Surgeons has included ultrasound as one of several “new technologies” that surgical residents must be exposed to in their curriculum. Both the American College of Emergency Physicians and the Society for Academic Emergency Medicine support the use of ultrasound to evaluate blunt abdominal trauma as well. Since 2001, training in emergency ultrasound has been required for all emergency medicine residents (2, 3 and 4). All physicians who will be evaluating trauma patients must become proficient in the use of trauma ultrasound. The objective of the FAST exam is to detect free intraperitoneal and pericardial fluid in the setting of trauma. The cardiac windows are especially critical in penetrating trauma and are reviewed in this section and in Chapter 3. In advanced applications of the FAST exam, pleural fluid and other signs of thoracic injury can be assessed as well.