Positioning the Probe

One of the practical considerations in FAST image acquisition is moving the patients arms, particularly when the cot sides are elevated. Obviously this can be difficult in a resuscitation setting.

Pericardial View

For the pericardial view, try the sub-typhoid approach first. Alternatively, the parasternal view may be better. In this instance, the marker should point down to the heart apex to gain a standard view.

Learning Bite

The marker on the probe should always be orientated towards the patient’s head, or to their right (except in the parasternal view)

RUQ view

Imagine the probe is a torch and imagine shining it towards the internal area which you want to see. For the RUQ view, start on the right side and site the probe just anterior to the mid-axillary line, angled and slightly backwards, to look at the anterior aspect of the renal capsule. It is crucial to visualize the caudal tip of the liver, as free fluid typically accumulates there first before appearing in Morrison’s pouch.

Learning Bite

For RUQ and LUQ views, start at the mid-axillary line and angle the probe slightly backwards: the LUQ probe position is always slightly higher.

LUQ view

The LUQ view is a little more difficult to obtain as the left kidney is higher than the right and therefore the view through an intercostal window may need to be obtained. Site the probe just posterior to the mid-axillary line, angled and slightly backwards, to look at the anterior aspect of the renal capsule. The spleno diaphragmatic space in the LUQ, must be visualised as this is the most common site for free fluid to accumulate initially.

Pelvis Sagittal View

For the pelvis sagittal view, position the probe as shown. A traverse view should also be obtained. In all patients (male or female), tilt/ fan the probe left and right to view the lateral borders of the bladder to view free fluid.

In males identify the bladder, prostate and rectovesical pouch. The rectovesical pouch is where free fluid will be accumulated. In females identify bladder, uterus and Pouch of Douglas, where fluid accumulates.