Clinical Guide

FAST and eFAST Protocol Guide

Emergency MedicineCritical Care / ICU

Overview

The Focused Assessment with Sonography for Trauma (FAST) exam is a rapid bedside protocol used to detect free fluid in the peritoneal and pericardial spaces. The extended eFAST adds bilateral pleural assessment for pneumothorax detection. This guide covers all four FAST windows and the two pleural views with practical scanning tips.

Key Clinical Points

1

Four standard FAST windows: perihepatic, perisplenic, pelvic (Morrison and splenorenal), and subcostal cardiac

2

Extended eFAST adds bilateral anterior chest views for pneumothorax

3

Free fluid appears anechoic (black) in the dependent spaces

4

Sensitivity improves with the patient in supine position

5

A positive FAST in an unstable patient warrants immediate surgical consultation

6

Use the convex probe (low frequency) for abdominal windows and the linear or phased array for cardiac and pleural

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