scholarly journals The FAST exam: overused and overrated?

2021 ◽  
Author(s):  
Justin Morgenstern
Keyword(s):  
Fast Exam

Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

POCUS Journal ◽  
2017 ◽  
Vol 2 (2) ◽  
pp. 15-17
Author(s):  
Rimi Sambi, MD ◽  
Heather Sawula, MD ◽  
Brent Wolfrom, MD ◽  
Joseph Newbigging, MD
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Point Of Care ◽  
Training Session ◽  
Undergraduate Curriculum ◽  
Knowledge Retention ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Medical Undergraduate ◽  
Fast Exam

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing [1]. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University. Third year medical students (n=18) were recruited to participate in a training session involving a 1-hour online video and 2-hour hands-on session. Knowledge based surveys were completed before and after the training. A survey was completed 4 months after the teaching session evaluating knowledge retention, comfort, and application of skills. Student knowledge of PoCUS and FAST increased and was maintained (pre-training 56%±20%, post-training 82%±10%, p<0.001). Self-evaluation of comfort performing a FAST examination (5-point Likert scale) similarly increased post-training session (pre-training 1.4±0.8, post-training 3.8±0.9, p<0.005), but decreased 4 months later (3±1.2, p<0.005). Students in this study were unanimously interested in ultrasound training and the methods used effectively increased theoretical knowledge and comfort with use. Students did not retain their comfort levels with FAST exam 4 months after the training session, nor did they have the opportunity to utilize the skills learned. Further evidence is required to identify the applicability of these results to undergraduate curriculum development.

Trauma to the Abdomen and Pelvis

2018 ◽  
Author(s):  
Zahir Basrai ◽  
Timothy Jang ◽  
Manuel Celedon
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Peritoneal Lavage ◽  
Penetrating Trauma ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Abdominal Organs ◽  
Fast Exam ◽  
Definitive Management ◽  
Endovascular Balloon Occlusion

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs.   This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

The Value of Abdominal and Pelvic CT Scan in Trauma Patients With Low Injury Severity Score and High Glasgow Coma Scale

2021 ◽  
pp. 000313482110474
Author(s):  
Tarik Wasfie ◽  
Daniel Rivera ◽  
Mursal Naisan ◽  
Shelby Zaremba ◽  
Mikayla Depuydt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Glasgow Coma Scale ◽  
Physical Examination ◽  
Injury Severity ◽  
Surgical Intervention ◽  
Trauma Patients ◽  
Ct Findings ◽  
Group A ◽  
Fast Exam ◽  
Group B

Introduction Computed tomography scans became the mainstay of emergency department (ED) evaluation of trauma patients including those with a high Glasgow Coma Scale (GCS) and a low Injury Severity Score (ISS). We elected to find the value of abdominal and pelvic CT in patients with negative physical examination and Focused Assessment of Sonography for Trauma (FAST) on arrival to the ED. Methods This study is a retrospective analysis of 901 consecutive patients from 2017 to 2019 who presented to the ED with level 2 and 3 activation criteria. Each patient received a physical examination, CT abdomen and pelvis, and FAST exam. Data were collected on external factor including GCS, ISS, age, sex, comorbidities, anticoagulation use, and surgical intervention. The patients were divided into 2 groups, Group A and B. Group A consisted of patients with a negative physical exam, FAST, and CT result. Group B included patients with a negative physical exam and FAST exam with positive CT findings. Statistical analysis was done using a Student’s t-test and chi-square test for significance value of P < .05. Institutional Review Board approval was obtained for this study. Results A total of 901 patients were analyzed which included 489 (54.3%) male and 412 (45.7%) female with a mean age of 56.2 (SD = 22.62) years. Out of the 901 patients, 461 patients received a physical, FAST, and CT exam. Group A consisted of 442 (95.9%) patients and Group B had 19 (4.1%) patients. Both groups were similar in GCS and ISS scoring with no significance difference in age, sex, comorbidities, and anticoagulation use. There was a significant difference in the ICU and hospital mean length of stay when CT scan was positive [2 (SD = 4.23) days vs. .6 (SD = 1.33) days with P < .0001 and 4.57 (SD ± 4.17) days vs. 2.5 (SD = 2.00) days with P < .0001, respectively]. The CT findings of the 19 patients in group B consisted of 6 incidentalomas, 5 vertebral compression fractures, 4 pelvic bone fractures, 1 minor liver contusion, 1 non-specific bowel thickening, 1 non-displaced rib fracture, and 1 case of small amount of free fluid in the pelvis. None of the CT findings required surgical intervention. Conclusion Computed tomography of the abdomen and pelvis in trauma patients with high GCS and low ISS with initial negative physical and FAST examination did not provide additional critical information.

Hypoxia

2018 ◽  
pp. 168-171
Author(s):  
Drew Clare
Keyword(s):  
Mechanical Ventilation ◽  
Airway Obstruction ◽  
Pulmonary Embolus ◽  
Positive Pressure ◽  
Potential Development ◽  
Normal Chest Radiograph ◽  
Normal Chest ◽  
Chest X Ray ◽  
Fast Exam ◽  
Delayed Pneumothorax

The case illustrates the approach to an intubated patient on mechanical ventilation with desaturation and clinical deterioration. Included is a list of potential etiologies, including airway obstruction, pneumothorax, mucus plug/atelectasis, aspiration or infection, and pulmonary embolus as well as a description of how to systematically evaluate these patients. Various imaging modalities are reviewed, including the findings of a chest X-ray and results of a limited bedside ultrasound. The case highlights the potential development of a delayed pneumothorax or hemothorax, despite an initially normal chest radiograph, particularly with the addition of positive pressure ventilation. The case highlights the importance of the focused assessment with sonography for trauma (FAST) exam.

Abdominal ultrasound image acquisition and interpretation by novice practitioners after minimal training on a simulated patient model

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S62-S66
Author(s):  
Bradley Waterman ◽  
Kristine Van Aarsen ◽  
Michael Lewell ◽  
Homer Tien ◽  
Frank Myslik ◽  
...  
Keyword(s):  
Critical Care ◽  
Training Session ◽  
Ultrasound Image ◽  
Abdominal Ultrasound ◽  
Free Fluid ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Didactic Training ◽  
Training Course ◽  
Fast Exam

AbstractBackgroundThe Focused Assessment with Sonography in Trauma (FAST) exam is a rapid ultrasound test to identify evidence of hemorrhage within the abdomen. Few studies examine the accuracy of paramedic performed FAST examinations. The duration of an ultrasound training program remains controversial. This study's purpose was to assess the accuracy of paramedic FAST exam interpretation following a one hour didactic training session.MethodsThe interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model containing 300ml of free fluid following a one hour didactic training course. Results were compared using the Chi-square test. Differences in accuracy rate were deemed significant if p < 0.05.ResultsFourteen critical care flight paramedics and four emergency physicians were voluntarily recruited. The critical care paramedics were mostly ultrasound-naive whereas the emergency physicians all had ultrasound training. The correct interpretation of FAST scans was comparable between the two groups with accuracy of 85.6% and 87.5% (∆1.79 95%CI -33.85 to 21.82, p = 0.90) for paramedics and emergency physicians respectively.ConclusionsThis study determined that critical care paramedics were able to use ultrasound to detect free fluid on a simulated mannequin model and interpret the FAST exam with a similar accuracy as experienced emergency physicians following a one hour training course. This suggests the potential use of prehospital ultrasound to aid in the triage and transport decisions of trauma patients while limiting the financial and logistical burden of ultrasound training.

scholarly journals Caudal Edge of the Liver in the Right Upper Quadrant (RUQ) View Is the Most Sensitive Area for Free Fluid on the FAST Exam

2017 ◽  
Vol 18 (2) ◽  
pp. 270-280 ◽  
Author(s):  
Viveta Lobo ◽  
Michelle Hunter-Behrend ◽  
Erin Cullnan ◽  
Rebecca Higbee ◽  
Caleb Phillips ◽  
...  
Keyword(s):  
Free Fluid ◽  
Sensitive Area ◽  
Fast Exam ◽  
The Right

scholarly journals Ureterocele found incidentally on focused assessment with sonography for trauma (FAST) exam

2015 ◽  
Vol 11 (7) ◽  
pp. 1023-1024
Author(s):  
Adam Ash ◽  
Tanya Bajaj ◽  
Christopher Raio
Keyword(s):  
Fast Exam

scholarly journals Point of care ultrasound in disaster triage

2017 ◽  
Vol 86 (1) ◽  
pp. 38-39
Author(s):  
Brandon Chau ◽  
Gayathri Sivakumar
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Accurate Method ◽  
Point Of Care Ultrasound ◽  
Life Threatening ◽  
Intraperitoneal Bleeding ◽  
Ultrasound Technology ◽  
Fast Exam ◽  
Disaster Scenario ◽  
The Military

Ultrasound technology has rapidly progressed over the past decades to emerge as a portable, versatile imaging modality to complement the physical exam. It has been shown to be superior to clinical exam and equivalent to computed-tomography in detecting many life-threatening conditions, and thus is used in a variety of resuscitative settings, including the front lines of the military. A variety of imaging protocols exist for ultrasound, but in resource-deplete settings such as a disaster scenario, the focused assessment with sonography for trauma (FAST) exam is a rapid and accurate method of determining acute intraperitoneal bleeding. With improving portability, as well as the ability to transmit images to a centralized command hub, it can become a key component of the first responder’s toolkit.

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