FAST, e-FAST and CT Angiography in Polytrauma
DNB Orthopaedics • October 2024 • Paper III • 10 Marks
Introduction
Abdominal and pelvic injuries are important occult sources of haemorrhage in polytrauma. Imaging must therefore be selected according to the patient's haemodynamic status.
Core trauma principle
Unstable patient → rapid bedside assessment and haemorrhage control.
Stable patient → detailed cross-sectional imaging.
A. FAST — Focused Assessment with Sonography for Trauma
FAST is a rapid bedside ultrasonographic examination designed primarily to identify free fluid in body cavities following trauma.
In the abdomen, free intraperitoneal fluid in trauma is presumed to be blood until proved otherwise.
Standard FAST Views
| View | Region Examined | Important Space |
|---|---|---|
| RUQ | Liver–right kidney | Morrison pouch / hepatorenal recess |
| LUQ | Spleen–left kidney | Splenorenal recess |
| Pelvic | Pelvis around bladder | Rectovesical pouch in male / pouch of Douglas in female |
| Pericardial | Heart | Pericardial fluid / tamponade |
FAST Examination — Simple Diagram
Pericardial view
↓
[ HEART ]
RUQ LUQ
↓ ↓
[Liver-Kidney] [Spleen-Kidney]
Morrison pouch Splenorenal space
↓
Pelvis
around urinary bladder
FAST looks for free fluid in:
Pericardium + RUQ + LUQ + Pelvis
e-FAST — Extended FAST
e-FAST extends the conventional FAST examination to include assessment of the chest.