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 exam | Preferred 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.