I've wanted to discuss tips and pitfalls for the FAST exam for a while now, but I needed a master to talk with. Luckily at Castlefest, I met Laleh Gharahbaghian, MD. She is the Ultrasound Director at Stanford's Dept. of Emergency Medicine as well as being too cool for school. She is also FOAMY with what I think is the best blog on all things point-of-care ultrasound: sonospot.com.

Sonospot Posts on the FAST

I was going to write up comprehensive show notes for this episode, but thankfully Laleh published a post that encompasses EVERYTHING we we spoke about. So go read the ultimate blogpost on the FAST exam.

The Right-Upper Quadrant

• SonoTutorial: The FAST Part 1: The right upper quadrant – the right way to do it
• SonoTutorial: The FAST Part 1a: The Right Upper Quadrant: Images That Could Fool You
• SonoTutorial: The FAST Part 1b: The Right Upper Quadrant: More images that could fool you
• Optimizing RUQ images

Update: Here is the article on Trendelenburg for Optimal RUQ (Am J Emerg Med 1999;17(2):118)

The Left-Upper Quadrant

• The FAST Part 2: Left Upper Quadrant
• SonoTutorial: The FAST Part 2a: Left Upper Quadrant – Images that could fool you…
• SonoTutorial: The FAST Part 2b: Left Upper Quadrant – More images that could fool you

The Pelvic View

• Sonospot will have a post on this coming up soon

The Heart

• SonoTips & Tricks: The FAST scan: The Cardiac views #FOAMed

• SonoTip&Trick: “I can’t tell if it’s a pleural or pericardial effusion.” Really? well here’s a tip

Pneumothorax

Laleh's post on a large pneumothorax trial

FAST is Specific for IntraABD Hemorrhage

J Trauma 2020;90(1):137

Why do we mess up the exam?

Laselle et al. published on why false-negative FASTs occurred [Ann Emerg Med 2012;60:326]. See this wonderful post from the Sonospot blog on the Laselle article and false-negative FASTs.

Want more?

• Head on over to the Ultrasound Podcast for more from my friend Cliff Reid
• And here, Jacob does it in 5 minutes

Updates:

Finally a study demonstrating that you MUST see the liver tip (Caudal Edge of the Liver in the Right Upper Quadrant (RUQ) View Is the Most Sensitive Area for Free Fluid on the FAST Exam; Western Journal of Emergency Medicine Permalink:http://escholarship.org/uc/item/2wh596n6)

More from Laleh on a future episode, but now on to the Podcast…

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Scott Weingart, MD FCCM

Editor-in-Chief, at EMCrit.org

An ED Intensivist from NY.
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).

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