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Focused assessment with sonography in trauma (FAST) for the regional anesthesiologist and pain specialist
  1. William Clark Manson1,
  2. Meghan Kirksey2,
  3. Jan Boublik3,
  4. Christopher L Wu4 and
  5. Stephen C Haskins4
  1. 1 Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
  2. 2 Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York City, New York, USA
  3. 3 Anesthesiology, Stanford Hospital and Clinics, Palo Alto, California, USA
  4. 4 Anesthesiology, Hospital for Special Surgery, New York City, New York, USA
  1. Correspondence to Dr William Clark Manson, Anesthesiology, University of Virginia Health System, Charlottesville, VA 22908-0816, USA; wmanson{at}


This article in our point-of-care ultrasound (PoCUS) series is dedicated to the role the focused assessment with sonography in trauma (FAST) exam plays for the regional anesthesiologist and pain specialists in the perioperative setting. The FAST exam is a well-established and extensively studied PoCUS exam in both surgical and emergency medicine literature with over 20 years demonstrating its benefit in identifying the presence of free fluid in the abdomen following trauma. However, only recently has the FAST exam been shown to be beneficial to the anesthesiologist in the perioperative setting as a means to identify the extravasation of free fluid into the abdomen from the hip joint following hip arthroscopy. In this article, we will describe how to obtain the basic FAST views (subcostal four-chamber view, perihepatic right upper quadrant view, perisplenic left upper quadrant view, and pelvic view in the longitudinal and short axis) as well as cover the relevant sonoanatomy. We will describe pathological findings seen with the FAST exam, primarily free fluid in the peritoneal space as well as in the pericardial sac. As is the case with any PoCUS skill, the application evolves with understanding and utilization by new clinical specialties. Although this article will provide clinical examples of where the FAST exam is beneficial to the regional anesthesiologist and pain specialist, it also serves as an introduction to this powerful PoCUS skill in order to encourage clinical practitioners to expand the application of the FAST exam within the scope of regional anesthesia and pain management practice.

  • point-of-care ultrasound
  • FAST exam
  • trauma

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  • Contributors JB, SCH, and CLW developed the idea for the paper. WCM planned and designed the paper. WCM, MK, JB, and SCH all contributed to writing and editing this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.