The Basic Pediatric (FAST) Focused Assessment with Sonography in Trauma
July 29, 2021ID6849
To CiteDCA Citation Guide
- 00:15So when I do a fast, I usually start with
- 00:18the right upper quadrant view and I'd like
- 00:20to start in the anterior humoral line,
- 00:23looking for rib space.
- 00:24And and looking again,
- 00:26we're going to illustrate a couple
- 00:28of different movements.
- 00:29One is this so called,
- 00:31rocking looking superiorly entirely.
- 00:32And this is called fanning,
- 00:34looking anteriorly and posteriorly
- 00:35and rotating sometimes if we
- 00:37need to get between two ribs.
- 00:39But this is a pretty good image.
- 00:41Then I'm sliding up and down towards
- 00:45inferior pole of the right kidney.
- 00:48So that's a complete write
- 00:49up a project video.
- 00:59The next few, since we're in the territory,
- 01:01we can do a sub typhoid view.
- 01:03Again, you're putting the chance you
- 01:05shirt it's a diaper region aiming up.
- 01:07Sometimes it's easier to put the hand on
- 01:09top of the transition and then a month,
- 01:12and then Antonio is going to help me
- 01:14change the depth so that it's part.
- 01:19Again, that you might find this
- 01:21difficult in the skinny patient,
- 01:22it's very difficult to get a very good
- 01:24window will show you on the cardiac
- 01:26views where you can get a question along
- 01:28Axis which looks very similar to this.
- 01:38The next thing we look at is
- 01:40left Upper Quadrant View,
- 01:41where you can put your hand really
- 01:43almost at the bottom of the bed.
- 01:47Looking at the spleen again,
- 01:49you're going to be fanning to
- 01:51look more anteriorly that stomach
- 01:52full of snack after school.
- 01:54Looking closely fanning that gets
- 01:56you the left kidney and sliding
- 01:58up to see the rich shadow or the
- 02:01diaphragm is sliding down to see the
- 02:03inferior pole of the left kidney.
- 02:07Ferguson artifact.
- 02:08Do you have meddling or rib today?
- 02:10I don't know some hydronephrosis.
- 02:12Joshua this is so as muscle.
- 02:22Super pubic you again.
- 02:23You want to put the transducer
- 02:25right over the pubic synthesis,
- 02:26which is right here.
- 02:29And then looking transversely first.
- 02:33Any blood in any free through broadband blood
- 02:36any free flight collect behind the platter,
- 02:39either the transfers or the sagittal view.
- 02:41Then you rotate the transducer with
- 02:44indicator towards the head of the patient.
- 02:46Again, the free fluid would be behind
- 02:49in the colder sack in the female
- 02:51patient behind the bladder, in the mail.
- 03:02Remember the first examination you are
- 03:04looking for an answer to the question.
- 03:06Do I see free fluid? Yes or no?
- 03:09It is either positive or negative.
- 03:12It is not designed to tell you where
- 03:15the fluid is leaking from or why the
- 03:18patient is bleeding in the first place.
- 03:20Fluid yes no.
- 03:21Is the question we will answer.
- 03:36This is what a pericardial
- 03:38effusion would look like.
- 03:39You can see how the heart seems pushed
- 03:41to the side by a large amount of fluid.
- 03:44This is a positive fast,
- 03:46although the view obtained in this
- 03:48case is a parasternal long axis and
- 03:51not typically part of the fast.
- 03:53We just wanted to show you what a large
- 03:56pericardial effusion would look like.
- 04:11You will see the liver closest to
- 04:13the transducer and then the kidneys.
- 04:16This is the positive or negative fast.
- 04:21As you can see, there is
- 04:23fluid in the Morrison's pouch,
- 04:24so this fast is positive.
- 04:26The CT scan on the right shows you
- 04:28an intra abdominal fluid collection,
- 04:30confirming that you were right.
- 04:34Here you can see a very small dark
- 04:36line between the liver and kidney.
- 04:39It may be small,
- 04:40but still counts as positive.
- 04:42Remember, a fast is either
- 04:43positive or negative,
- 04:44not a little bit positive.
- 04:59Is this positive or negative?
- 05:02Yes, you know it.
- 05:04There is fluid between the
- 05:05diaphragm and the spleen.
- 05:06It is positive.
- 05:09Positive or negative?
- 05:12Yep, you know it. It is positive
- 05:13there is a small fluid collection.
- 05:39Here you can see free fluid
- 05:41behind the bladder representing
- 05:42a positive fast examination.
- 05:44As you can see on the picture on the right,
- 05:47it was confirmed by a CT scan.
- 05:51Alright, ready for some cases.
- 05:54I want you to first name the view and
- 05:56second point out the pathology. Let's go.
- 06:05Yes, you're right,
- 06:06we used a curvilinear probe and this
- 06:09is the right upper quadrant view.
- 06:11The fast is positive.
- 06:13You can clearly see free fluid
- 06:15on the left lobe of the liver.
- 06:17And at Morrisons pouch.
- 06:19Ready for the next one?
- 06:27Good job, we were using a
- 06:29curvilinear probe and this is
- 06:30the right upper quadrant view.
- 06:32It is positive because there is
- 06:34a tiny amount of free fluid at
- 06:37the inferior pole of the spleen.
- 06:40OK, advance to the next slide.
- 06:42Take your time.
- 06:55Yes, we used a curvilinear probe and
- 06:58we're looking at the right pleural space.
- 07:01You correctly identified the
- 07:03pleural effusion. We will cover the
- 07:06lung and pleural pathologies in a
- 07:08separate lecture though. Next case.
- 07:17We used a curvilinear probe
- 07:19and this was a pelvic view.
- 07:21It is positive for free fluid.
- 07:24Remember, in pediatric cases,
- 07:26most positive fast scans
- 07:27are seen on pelvic views,
- 07:30in contrast with adults where
- 07:32the Morrisons pouch view is
- 07:34the most commonly positive.
- 07:37Stromberg one less case,
- 07:38and you're done.
- 07:47Perfect, we used a phased array transducer
- 07:50and this was a subset food view.
- 07:53There is a large pericardial effusion.