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Home > Articles > Focused Assessment with Sonography for Trauma (FAST)


The use of focused ultrasonography has now become an extension of the physical examination of the trauma patient. Performed in the trauma room by properly trained and credentialed staff, it allows the timely diagnosis of potentially life-threatening haemorrhage and is a decision-making tool to help determine the need for transfer to the operating room, CT scanner or angiography suite.

Ultrasound was first utilised for the examination of trauma patients in the 1970s in Europe, where its qualities for being a noninvasive, rapid, safe, accurate and repeatable bedside assessment were first appreciated. It's uptake in North America and the United Kingdom did not occur until the 1990s. Since that time a considerable body of data has been produced to support its use in the assessment of the trauma patient.

Focused Assessment with Sonography for Trauma (FAST) is a limited ultrasound examination directed solely at identifying the presence of free intraperitoneal or pericardial fluid. In the context of traumatic injury, free fluid is usually due to haemorrhage and contributes to the assessment of the circulation.

The Focused Assessment with Sonography for Trauma is a rapid, bedside, ultrasound examination performed to identify intra-peritoneal haemorrhage or pericardial tamponade.

FAST examines four areas for free fluid:

  1. Perihepatic & hepato-renal space
  2. Perisplenic
  3. Pelvis
  4. Pericardium

FAST assessment is indicated in trauma patients who give a history of abdominal trauma, are hypotensive, or are unable to provide a reliable history because of impaired consciousness due to head injury or drugs. FAST is an adjunct to the ATLS primary survey and therefore follows the performance of the ABCs. The ultrasound machine should be immediately available in the trauma room and its use should not interfere with the on-going assessment and management of the patient.

Small, portable ultrasound machines are now available which are highly appropriate to the trauma room environment. Standard FAST assessment is carried out using a curvilinear 2.5 or 3.5MHz probe.

How to perform the FAST examination

Perihepatic scan

The hepatorenal space (pouch of Rutherford-Morison) is the most dependent part of the upper peritoneal cavity and small amounts of intra-peritoneal fluid may collect in this region first. Blood shows as a hypoechoic black stripe between the capsule liver and the fatty fascia of the kidney. The probe is placed in the right mid- to posterior axillary line at the level of the 11th and 12th ribs.

Probe position for RUQ Hepatorenal view
No free fluid Fluid in hepatorenal space

Perisplenic scan

The left upper quadrant examination visualises the spleen and perisplenic areas. The transducer is placed on the left posterior axillary line region between the 10th and 11th ribs.

Probe position for LUQ
No free fluid Perisplenic free fluid

Pelvic scan

The pelvic examination visualises the cul-de-sac: the Pouch of Douglas in females and the rectovesical pouch in the male. It is the most dependent portion of the lower abdomen and pelvis, hence where fluid will collect. The transducer is placed midline just superior to the symphysis pubis.

Probe position for pelvis
No free fluid Pelvic free fluid

Pericardial sub-xiphoid scan

The pericardial examination screens for fluid between the fibrous pericardium and the heart, and hence possible cardiac tamponade. The transducer is placed just to the left of the xiphisternum and angled upwards under the costal margin.

Probe position for pericardium Pericardial view
Normal pericardium Pericardial fluid


adeniyigbesan, October 24, 2007

Iam impressed on FAST can make Trauma injury diagnosis easier and prompt.

Can you link up to where Ican be trained to apply FAST


nohemi greeny, November 08, 2007

can you link up the couses for ER phisicians
to be trained for FAST

Manolis, Heraklion, Crete, Greece, November 24, 2007

have the same question: are there any online courses for FAST?
by the way, great resources.
thank you.

altraifi, December 08, 2007

very nice .pls if more of percadium views are shown

cdussault, January 22, 2008

Does the FAST eliminate the need to have DPL - diagnostic peritoneal lavage set-ups available in the trauma room?

cbleeker, August 22, 2008

In Europe the PREP course is taught. It consists of the FAST plus thoracic ultrasound. The original course was in French but it is given in other languages and countries as well (NLD). One of the experiences with the PREP exam in the pre-hospital setting is that it prevents many thoracic drains which normally might be inserted because of reduced breath sounds.

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