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    Patent Pending

    Focused Assessment with Sonography for Trauma (FAST)

    Predicts presence of pericardial or intra-abdominal injury after penetrating or blunt trauma.

    INSTRUCTIONS

    FAST results alone should not dictate the decision to operate, and negative FAST does not exclude injury. This calculator is meant to help with interpretation of FAST findings, which are at least partially dependent on the user's sonographic technique.

    When to Use
    Pearls/Pitfalls
    Why Use
    • FAST should be used liberally in the evaluation of trauma patients.
    • Especially useful in patients with penetrating thoracic trauma and in unstable patients after blunt abdominal trauma.
    • Assesses for fluid in the pericardium or abdomen (hemopericardium or hemoperitoneum, respectively).
    • The traditional four views consist of a subxiphoid view of the heart and pericardium, right and left upper quadrant windows, and the pelvis.
    • More recently, the extended FAST (eFAST) has entered into clinical practice with the addition of bilateral thoracic views to assess for pneumo- and hemothoraces.
    • Negative FAST does not exclude injury. Ultrasound is user dependent; therefore, clinicians should be cautious in interpretation of negative FAST. Sensitivities of abdominal and suprapubic views in FAST vary widely, with ranges of 22–98% reported in recent literature (Richards 2017, Carter 2015).
    • In penetrating thoracic trauma, pericardial view sensitivity approaches 100% (Matsushima 2017, Ball 2009, Rozycki 1999) but can miss cardiac injury if there is concomitant pericardial laceration allowing decompression into the left chest (Ball 2009).
    • If clinical suspicion for injury persists despite negative FAST, FAST should be repeated, additional investigations should be performed, or intervention should be pursued, depending on patient’s clinical condition.
    • For tips on ultrasound technique, see Next Steps > Advice.
    • FAST is a rapid, non-invasive, and repeatable imaging modality that can guide the surgeon in the decision to operate.
    • Performed in trauma bay (does not require patient transport out of the emergency department, which is risky in unstable patients).
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    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Grace Rozycki

    About the Creator

    Grace Rozycki, MD, MBA, is chief of surgery at Indiana University’s Methodist Hospital and the Willis D. Gatch Professor of Surgery and associate chair of the department of surgery at Indiana University School of Medicine. She previously served as chief of trauma and critical care at Grady Memorial Hospital in Atlanta. Dr. Rozycki has pioneered research on the application of surgeon-performed ultrasound in patients with post-trauma hemothorax, cardiac tamponade, hemoperitoneum, solid organ injuries, intra-abdominal abscesses, and femoral deep venous thrombosis.

    To view Dr. Grace Rozycki's publications, visit PubMed

    Are you Dr. Grace Rozycki? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Jennie Kim, MD
    Reviewed By
    • Morgan Schellenberg, MD, MPH
    • Kenji Inaba, MD, FRCSC, FACS
    About the Creator
    Dr. Grace Rozycki
    Are you Dr. Grace Rozycki?
    Partner Content
    Content Contributors
    • Jennie Kim, MD
    Reviewed By
    • Morgan Schellenberg, MD, MPH
    • Kenji Inaba, MD, FRCSC, FACS