For the fast exam, not to be confused with the slow exam, like what they do over at UNC. Just kidding, they're great over there. Just wouldn't be a Duke talk without giving a little ribbon over to UNC. But anyway, so the fast exam, there's four probe positions. You wanna do the right upper quadrant, left upper quadrant, pelvic or bladder, as well as a sub-xiphoid view to look at the heart. The data's pretty variable about the exact sensitivity of a fast exam. And some of it depends on how quickly after the injury and other things. But it's about 40% sensitive, and it's about over 95% specific for peritoneal free fluid concerning for an intra-abdominal injury and bleeding. So going through the fast exam here. So the first view that we'll talk about is the sub-xiphoid view. So as you can see kind of on the left here is a normal sub-xiphoid view. So you can see the heart, no free fluid, that hypoechoic free fluid around there. And then on the right side, you do see free fluid around the heart concerning for that pericardial effusion and injury there. Moving right along to the right upper quadrant view. Here on the left, you can see a normal view, and you're looking at the interface between the liver as well as the right kidney. And you wanna look in between there and look for any hypoechoic areas. But also I wanna give mention to the caudal tip of the liver here. And you also wanna take a look there to make sure there's no free fluid around there because sometimes the blood can hide there. And on the right here, we have our positive red arrow sign showing the hypoechoic abnormal fast exam here of showing that free fluid in between the kidney and the liver concerning for intra-abdominal injury. Moving along to the left upper quadrant view, we have the spleen and the kidney. And here I wanna mention, you wanna make sure you look between the spleen and the kidney, but actually even more commonly, the free fluid goes between the spleen and the diaphragm as documented in this right picture here. So you can see the spleen, the kidney interface actually looks good. There's no free fluid there, but luckily this sonographer looked above the spleen as well and saw the free fluid. And then the bladder view. So you usually wanna actually get both a transverse and a longitudinal on the bladder view. But we're looking at the transverse here, looking at a normal, you don't see any hypoechoic around the bladder other than the hypoechoic fluid or urine inside the bladder, but you can see kind of the bladder wall there closing it off. And here you can see the bladder wall closing off the hypoechoic urine, but then there's also some free fluid or blood there. So this is another abnormal exam.

2nd Edition, Case 01

2nd Edition

Abdomen

FAST exam

ultrasound assessment

peritoneal free fluid

intra-abdominal injuries

probe positions