Pitfalls

There are many pitfalls in carrying out a FAST scan that include:

• Failure to be clear why FAST is indicated
• Assuming free fluid is blood
• Saying a negative scan is a normal scan
• Not repeating scans
• Carrying out a scan while the patient is sitting at 45 degrees
• Ruling out pathology, rather than using FAST to rule in pathology
• Failure to work to the algorthym

At all times think about the history and context, and ensure you are attempting to answer a legitimate question.

Top tips for EFAST

• While examining the RUQ & LUQ, the structures shift with the diaphragm’s movement during the respiratory cycle. Consider asking the patient to hold their breath to stabilize the targeted organs.
• Rib shadows can make optimal image acquisition difficult and hence consider rotating the probe such that it fits between rib spaces.
• For LUQ imaging, your knuckles should rest on the bed as the spleen is quite posterior.
• The bladder lies directly posterior to the pubic symphysis and requires you to be quite inferior into the pelvic inlet for optimal images.
• The subcostal view is a good place to start for ELS imaging as it doesnt interrupt chest compressions and can be used during rhythm checks.