Abstract
Study objectivesAlthough the focused assessment with sonography in trauma (FAST) examination was initially developed for rapid evaluation of trauma patients, the basic skillset required to perform a FAST examination provides valuable information that may alter a non-trauma patient’s clinical course. The objective of this study was to determine the utility of the FAST examination in the emergency department management of non-trauma patients.MethodsCases in which the FAST examination was used to direct care in non-trauma patients were retrospectively reviewed. Following the completion of the patient's care, emergency physicians were asked to complete a questionnaire indicating how information from the FAST examination was utilized to direct care of their non-trauma patients.ResultsA total of 63 non-trauma cases with average age of 48 years (range 16-94 years) were enrolled. The FAST examination positively impacted care in 57/63 (90.5%) cases. In 18/63 (28.6%) cases, the patient’s ultimate disposition changed because of FAST examination findings. In 9/63 (14.3%) cases, paracentesis was avoided by obtaining a FAST examination, and in 8/63 cases (12.7%) paracentesis was performed due to FAST examination results. In 16/63 (25.4%) cases, anticipated imaging changed due to FAST examination findings and 4/63 (6.3%) cases did not receive the anticipated computed tomography (CT) scan.ConclusionsAlthough initially developed for evaluation of trauma patients, the FAST examination can provide valuable information that can positively impact care in non-trauma patients. The FAST examination can provide information to determine appropriate patient disposition, obtain appropriate additional imaging, ensure timely consultation, and eliminate risk from unnecessary procedures.
Highlights
Focused assessment with sonography in trauma (FAST) examination is routinely used in the emergency department (ED) to evaluate trauma patients
In 9/63 (14.3%) cases, paracentesis was avoided by obtaining a focused assessment with sonography in trauma (FAST) examination, and in 8/63 cases (12.7%) paracentesis was performed due to FAST examination results
Appropriate acquisition of images and accurate interpretation of the FAST examination requires a thorough understanding of sonographic anatomy and anatomical variance, and an understanding of the various pathologic processes that may be present in each quadrant of the FAST examination
Summary
Sonographers should be able to identify normal cardiac activity, epicardial fat pad, diaphragm, spine, liver, spleen, kidney, perirenal fat, urinary bladder, etc. Unfamiliarity of these structures’ normal sonographic anatomy could result in misinterpretation and inappropriate interventions. It is foundational for sonographers to learn sonographic anatomy well, in hopes to identify abnormal free fluid in between or surrounding these structures These skills are taught and emphasized by point-ofcare (POC) ultrasound educators when teaching FAST examination skills. There are a number of applications where the FAST examination can be utilized in non-trauma patients, including but not limited to: 1) detection of free fluid in patients with suspected ruptured ectopic pregnancy or ruptured ovarian cyst, 2) evaluation for presence or absence of ascites in patients with suspected spontaneous bacterial peritonitis and subsequent procedural guidance if paracentesis is warranted, 3) detection of cardiac activity during cardiopulmonary resuscitation (CPR), 4) narrow the differential diagnosis of patients with shortness of breath (pleural effusion/pericardial effusion), 5) evaluation of the bladder in patients with urinary retention and guidance of subsequent foley catheter placement, 6) detection of hydronephrosis in patient with suspected nephrolithiasis, 7) urinary bladder evaluation prior to performing straight catheterization of the bladder in children, 8) evaluation for free fluid in hypotensive patients with concern for abdominal aortic aneurysm
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