Jax Emergency Medicine Ultrasound: Faster FAST

The FAST exam was created as a rapid screening test to detect free fluid in the abdomen, but how can you get the FAST exam done, well, fast? It seems like it always takes 5 minutes to find the correct views in the trauma center with X-ray breathing down your neck to get in for the CXR. So how can we get the FAST exam done faster? Here are 5 tips to make you a faster FASTer!

1. Find Morrison's pouch without the search: I have found that the quickest way to identify where to place the probe for your RUQ view consistently every time just requires a quick look at the chest before you even touch the patient. Looking at the chest wall, notice how the ribs crate a horizontal line until a point where they begin to drop off at an angle.

At this point, draw an imaginary line down to the bed. Place your probe at that point and ...viola, Morrison's Pouch!

2. Know where LUQ view should be: so now that you have easily located your RUQ view and Morrison's Pouch, you can use that information to find the LUQ view. Draw an imaginary line across the patients chest from the RUQ view point to the left coronal plane.

Once you find this point, place your probe one rib space cranial of this point. Now you should see the LUQ view.

3. Remember that the kidney are retroperitoneal: One of the biggest mistakes that I see is that someone will place the probe in the correct location, but will angle the probe anteriorly. Recall the relationship between the kidney and the major vessels.

Note on this transverse view of the abdomen that the kidney are more posterior than the IVC and Aorta. So when you angle anterior, you are aiming you sound beam at the major vessels and not the kidney/liver or kidney/spleen junction.

So if you angle your sound beam toward the bed or posterior, then the RUQ or LUQ view comes into view.

The key is angling toward the bed on both sides of the patient.

4. Pelvic view: just as angling the probe posteriorly is essential to locating the kidneys, the angle of the sound beam is essential to locating the bladder for the pelvic view. I always start in the transverse plane when attempting to visualize the bladder. In this plane the bladder is easier to identify as a square. Place the probe just superior to the pubic bone.

Now, angle the sound beam toward the patient's feet.

If you are unable to see the bladder, then increase your angle and the bladder will come into view.

5. Subxiphiod view: When attempting this view, remember that we are scanning structure that are a lot farther from our probe than in the other views. We are going through the liver, past the diaphragm and the getting to the heart. So you must increase your depth of scan.