"FOCUSED ASSESSMENT WITH SONOGRAPHY IN TRAUMA"
Scanning Basics
Adjust bed height for your comfort so you are not reaching
across patient
Keep screen at eye level
Run finger along transducer to confirm orientation
Rest scanning small finger on patient to stabilize your
transducer
(helps
minimize transducer movements)
Overhand grip for subxiphoid image
If bowel gas obscures imaging, firm pressure with your
transducer or nondominant hand
Scan completely through structures in 2 planes with SMALL
movements
Scanning protocol
Ensure Abdomen presets are selected for your transducer
Optimize Image quality
Depth: area
of interest fills roughly 2/3rd of the screen
Gain:
appropriate level for fluid (black), tissue (grey), and diaphragm (white)
Focus: set
to the area of interest (e.g hepatorenal recess)
Tissue
Harmonic Imaging (as needed): sharpens image by decreasing signal from
fat layers and
increasing edge definition
Ensure the following images are saved to the ultrasound
machine:
RUQ (Morrison’s pouch or
Hepatorenal recess)
- Diaphragm, liver, right kidney
LUQ (splenorenal recess)
- Diaphragm, spleen, left kidney
Pelvis (retrovesicular view)
- Bladder in short and long axis
Subxiphoid
- Left
lobe of liver, pericardium, 4 chamber of the heart
Additional Imaging
Windows
Right and Left Hemithorax
- 2D
image with lung sliding and comet tails
- M-Mode
image
The most common technical errors that occur for physicians
learning the FAST exam are:
Poor gain
Suboptimal depth
Backwards orientation
One view that is noninterpretable
- splenorenal
- subxiphoid
Right Upper Quadrant
[place image here]
Longitudinal
Aim posteriorly and laterally
(indicator to patient’s head)
Image
diaphragm/liver/kidney/psoas
Deep breath
and hold may help
Excessive
rib shadows may be mitigated by placing probe parallel to costal space
Left Upper Quadrant
[place image here]
Longitudinal
Aim posteriorly and laterally (indicator
to patient’s head)
The left kidney is higher and more
lateral than the right kidney
Image
diaphragm/spleen/kidney/psoas
Subxiphoid
Longitudinal
Place
transducer inferior to xyphoid process and angle superiorly
Readjust
depth to capture entire pericardial space
Bladder
Fill bladder as needed
Adjust TGC to remove reverberation artifact from anterior
bladder wall
Longitudinal
Place transducer as low as pubic
symphysis and angle inferiorly
Indicator marker to patient’s right
Scan
completely through bladder
Transverse
90ยบ
anticlockwise from LS view
J Trauma. 1995 Sep; 39(3):492-8; discussion 498-500.