Focused assessment with sonography for trauma: current perspectives

Abstract

Focused assessment with sonography for trauma (FAST) is a part of resuscitation of trauma patients recommended by international panel consensus. The purpose of FAST is to identify free fluid, which necessarily means blood in acute trauma patients. In this article, the authors focused on various aspects of FAST in the emergency department, prehospital care, pediatric setting, training and general pearls/pitfalls. Detailed techniques and interpretation of FAST are beyond the scope of this article.

Basic ultrasound training assessment in the initial abdominal trauma screening

“…Due to its low cost and easy implementation, this modality should be considered as a screening strategy for patients with abdominal trauma in health systems. than 96% in skilled hands 1,4 .…”

“…In this context, FAST has the objective of detecting the presence of free peritoneal fluid (FPF) in the primary assessment of patients victims of acute abdominal trauma 1,4 . The examination is performed in CT corresponds to the gold standard to detect FPF 1,4,6 .…”

“…However, there is limitation of its use in patients with hemodynamic instability due to the treatment urgency of these patients 1,4,6 .…”

“…Aiming to improve the initial screening of trauma patients, more than two decades ago the use of ultrasound (Focused Assessment with Sonography in Trauma -FAST) was incorporated into the initial assessment of trauma victims, under the approval of the American College of Surgeons, through the Advanced Trauma Life Support (ATLS) program 1,[4][5][6] . This evaluation tool resulted in a change in the diagnostic management of multiple trauma patients, replacing the peritoneal lavage method in the assessment of abdominal trauma, particularly in unstable patients 4,7,8 .…”

“…Physical examination in multiple trauma patients may be made difficult by the presence of several lesions, as well as the possibility of low level of consciousness level, shock of unknown etiology, central nervous system lesions and other clinical manifestations that make diagnosis difficult at the clinical examination only 1 . FAST consists of a non-invasive ultrasound examination that can be quickly performed by the patient's bedside, aiming to clarify specific clinical issues, regardless of the trauma mechanism that affected the patient 1,3,4,7,8 . Regarding FAST accuracy in the assessment of abdominal trauma, the sensitivity is 62% to 94% and the specificity is greater 1 -Universidade Estadual do Oeste do Paraná, Serviço de Cirurgia Geral, Cascavel, PR, Brasil.…”