A 20 y.o patient presents to the ED after a motor vehicle accident after hitting a ditch. He is fully alert and oriented and is reporting generalized abdominal pain and myalgias. Physical exam is notable for diffuse abdominal tenderness, seatbelt sign with bruising to the right upper chest wall and right flank. VS: HR 70, BP 108/59, RR 18, SpO2 99%
A FAST exam is performed which demonstrates the following:
A CT scan was subsequently performed which confirmed large volume hemoperitoneum with a grade 2 liver laceration.
The patient was subsequently taken to the OR for an exploratory laparotomy. He was ultimately stabilized, and was able to be discharged from the hospital 2 weeks later.
Focused Assessment with Sonography in Trauma: FAST
- Indication: Blunt and/or penetrating abdominal and/or thoracic trauma with associated hypotension
- Focused question: Is there free fluid in the pericardium or abdomen?
- Views: Right Upper quadrant, left upper quadrant, subxiphoid cardiac view, pelvic view
- Sensitivity of 74% for detection of intra-abdominal fluid
- Specificity of 98% for detection of intra-abdominal fluid
Resources:
Netherton, Stuart, et al. “Diagnostic accuracy of Efast in the trauma patient: A systematic review and meta-analysis.” CJEM, vol. 21, no. 6, 18 July 2019, pp. 727–738, https://doi.org/10.1017/cem.2019.381.
