FAST five ways


    FAST five ways

    The FAST exam is generally described as a trauma assessment (hence the acronym). But it is often used as a metanym to mean any assessment of the peritoneum for fluid. In fact when I was a resident folks would often say, “let’s FAST that gallbladder,” or “get the FAST machine so we can put that central line in.” And we didn’t have Twitter.

    Anyway, here are a few cases where the “FAST” was used in a non-trauma patient to assess the peritoneum:

    Cirrhotic with abdominal pain and tenderness:

    who was found to have ascites, and spontaneous bacterial peritonitis

    Lower abdominal pain in pregnancy:

    who was found to have hemoperitoneum from a ruptured ectopic pregnancy

    Diffuse abdominal tenderness in a healthy ten-year-old:

    who was found to have idiopathic seromas of the peritoneum, pleura, and pericardium!

    Shortness of breath and abdominal distension:

    which turned out to be massive abdominal abscesses

    Diffuse abdominal tenderness and distension after hysteroscopy:

    which was complicated by a bowel perforation; hence fecal material throughout the peritoneum

    Take home points:

    • Assessment of the peritoneum greatly aids medical and surgical diagnoses
    • Fluid appears black (anechoic) on ultrasound. Very difficult to tell what TYPE of fluid by appearance alone
    • Your clinical assessment must guide the differential diagnosis for your ultrasound findings