The initial screening tool for evaluation of the

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the initial screening tool for evaluation of the abdomen and thorax in trauma [ 10 –21]. In addition, in an era of cost consciousness, there is even evidence that shows that using FAST as a screening tool helps reduce testing, hospital stays, and intensive care unit requirements and thus can also significantly decrease cost [ 11 , 12 ]. Therefore, it is important to remember the strengths and weaknesses of all three diagnostic options for trauma. In this chapter, we discuss the FAST scanning technique, review positive and negative images, and present potential clinical algorithms for FAST use. Focused questions for the FAST exam The focused questions for the FAST exam are as follows: 1. Is there free fluid/blood in the abdomen? 2. Is there fluid/blood in the pericardium? There have also been a number of studies demonstrating the utility of ultra- sound in evaluating the thorax as part of the FAST examination to detect pneumothorax and hemothorax [ 22 –24]. This has been called the extended FAST (eFAST), and most trauma centers are now using this technique. We discuss ultrasound diagnosis of pneumothorax at the end of this chapter and show how the eFAST can diagnose blood in the thorax during the following discussion. For the eFAST, there are two additional focused questions: 3. Is there fluid/blood in the thorax? 4. Is there a pneumothorax? Anatomy The shape of the peritoneal cavity provides several dependent areas when a patient is in the supine position. The site of accumulation of fluid depends on the source of bleeding and the position of the patient. Because most trauma patients are transported supine on a backboard, we use this as the starting position. The right paracolic gutter runs from Morison’s pouch to the pelvis. The left paracolic gutter is not as deep as the right paracolic gutter. In addition, the phrenocolic ligament blocks fluid movement to the left paracolic gutter. As a result, fluid flows more freely toward the right paracolic gutter. The hepatorenal recess (Morison’s pouch) is the potential space located in the right upper quadrant (RUQ) between Glisson’s capsule of the liver and Gerota’s fascia of the right kidney ( Figures 2.1 –2.3). In a normal exam, there is no fluid between these two organs, and the fascia appears as a bright hyperechoic line separating the liver from the kidney. 28 Diagnostic ultrasound Focused assessment with sonography in trauma (FAST)
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The splenorenal recess is the potential space located in the left upper quadrant (LUQ) between the spleen and Gerota’s fascia of the left kidney ( Figures 2.4 and 2.5 ). Again, in the normal ultrasound exam of this quadrant, there is no fluid or hypoechoic area separating the spleen from the kidney, and the fascia appears as a bright hyperechoic line separating the two organs.
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