- Preparation
- Supine patient
- Use a curvilinear or phased-array probe (3.5–5 MHz)
- Apply generous ultrasound gel for good contact
- Standard FAST views (intra-abdominal and pericardial fluid)
- Right upper quadrant (RUQ):
- Probe placed longitudinally at midaxillary line, 8th–11th intercostal space
- Visualise liver, right kidney, diaphragm, Morison’s pouch
- Look for anechoic stripe (fluid) between liver and kidney
- Left upper quadrant (LUQ):
- Probe placed longitudinally, posterior axillary line, 8th–11th intercostal space
- Visualise spleen, left kidney, diaphragm, splenorenal recess
- Look for fluid between spleen and kidney
- Pelvic view:
- Transverse and longitudinal probe placement just superior to the pubic symphysis
- Look for fluid in pouch of Douglas (females) or rectovesical pouch (males)
- Subxiphoid (pericardial) view:
- Probe angled under the xiphisternum toward the left shoulder
- Visualise heart in long axis, with liver as acoustic window
- Look for fluid around heart (pericardial effusion or tamponade)
- Extended views (eFAST)
- Right anterior chest (pneumothorax):
- Probe placed in 2nd–4th intercostal space, midclavicular line
- Identify rib shadows, pleural line
- Look for lung sliding (normal)
- Absence of lung sliding or presence of barcode/stratosphere sign on M-mode suggests pneumothorax
- Lung point may be visible (transition between normal and absent sliding)
- Left anterior chest:
- Same technique as right side
- Right and left lower thorax (haemothorax):
- Use same RUQ and LUQ views
- Assess above diaphragm for anechoic fluid in pleural space
- Interpretation
- Presence of free fluid in peritoneum or pericardium, or absence of lung sliding, is considered positive
- A positive eFAST in an unstable trauma patient typically indicates need for surgical or procedural intervention