Table 5

The education and training goals for the focused assessment with sonography for trauma (FAST) exam following an Indication, Acquisition, Interpretation, and Medical decision-making framework

Education/training goals for the FAST examPreferred learning tool
Indications and background knowledge
(may be pre-existing)
 Basic physics of ultrasound
 Anatomy/sonoanatomy of the upper abdomen
 Indications for FAST exam
 Hypotensive trauma patient
 Hypotensive postoperative gynecological/obstetric patient (FASO)
 Re-evaluation of a trauma patient
 Abdominal pain following hip arthroscopy
 A patient who is critically ill in PACU
Didactics
Image acquisition Ergonomics
 Transducer selection
 Evaluate all four views of the FAST exam
 RUQ (Morison’s pouch)
 LUQ (perisplenic space including splenorenal interface)
 Pelvis views (longitudinal and transverse)
 Subcostal cardiac views
 Patient positioning
 Trendelenburg position can improve the sensitivity of RUQ/LUQ views
 Reverse-Trendelenburg position can improve the sensitivity of pelvic views
Hands on training
Image interpretation Scan for evidence of free fluid in
 Abdomen (RUQ/LUQ)
 Pelvis
 Pericardium
Hands on training
Medical decision-making Trauma assessment:
 Consider additional imaging if the patient is stable
 Proceed to the operating room for laparotomy if positive
 Intra-abdominal fluid extravasation (IAFE):
 Consider inpatient management for IAFE
 Postoperative shock:
 Consider returning to the operating room for surgical exploration
 Postprocedural shock:
 A concern of bleeding following interventional pain procedure and consider surgical consultation
Clinical case discussions
  • FASO, focused assessment with sonography for obstetrics; IVC, inferior vena cava; LUQ, left upper quadrant; PACU, postanesthesia care unit; RUQ, right upper quadrant.