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Focused Assessment with Sonography for Trauma (commonly abbreviated as FAST) is a rapid bedside ultrasound examination performed by surgeons and emergency physicians as a screening test for blood around the heart (pericardial tamponade) or abdominal organs (hemoperitoneum) after trauma.

The four areas that are examined for free fluid are the perihepatic space (also called Morrison's pouch or the hepatorenal recess), perisplenic space, pericardium, and the pelvis. With this technique it is possible to identify the presence of intraperitoneal or pericardial free fluid. In the context of traumatic injury, this fluid will usually be due to bleeding.



A positive FAST - fluid (black stripe, indicated by red arrows) within Morison's pouch.

FAST is less invasive than diagnostic peritoneal lavage, involves no exposure to radiation and is cheaper compared to computed tomography, but achieves a similar accuracy.[1]

Numerous studies have shown FAST is useful in evaluating trauma patients.[2][3][4][5] It also appears to make emergency department care faster and better.[6][7] However, some authorities still have not accepted its use.[8]


FAST is most useful in trauma patients who are hemodynamically unstable. A positive FAST result is defined as the appearance of a dark ("anechoic") strip in the dependent areas of the peritoneum. In the right upper quadrant this typically appears in Morison's Pouch (between the liver and kidney). In the left upper quadrant, blood may collect anywhere around the spleen (perisplenic space). In the pelvis, blood generally pools behind the bladder (in the rectovesicular space or Pouch of Douglas). A positive results suggests hemoperitoneum; often CT scan will be performed if the patient is stable[9] or a laparotomy if unstable. In those with a negative FAST result, a search for extra-abdominal sources of bleeding may still need to be performed.[9]


  1. Rozycki G, Shackford S (1996). "Ultrasound, what every trauma surgeon should know". J Trauma 40 (1): 1–4. doi:10.1097/00005373-199601000-00001. PMID 8576968.
  2. Dolich MO; McKenney MG; Varela JE; Compton RP; McKenney KL; Cohn SM (Jan 2001). "2,576 ultrasounds for blunt abdominal trauma". Journal of Trauma 50 (1): 108–12. doi:10.1097/00005373-200101000-00019. PMID 11231679.
  3. Farahmand N; Sirlin CB; Brown MA; Shragg GP; Fortlage D; Hoyt DB; Casola G (May 2005). "Hypotensive patients with blunt abdominal trauma: performance of screening US". Radiology 235 (2): 436–43. doi:10.1148/radiol.2352040583. PMID 15798158.
  4. Sirlin CB; Brown MA; Andrade-Barreto OA; Deutsch R; Fortlage DA; Hoyt DB; Casola G (Mar 2004). "Blunt abdominal trauma: clinical value of negative screening US scans". Radiology 230 (3): 661–8. doi:10.1148/radiol.2303021707. PMID 14990832.
  5. Moylan M; Newgard CD; Ma OJ; Sabbaj A; Rogers T; Douglass R (Oct 2007). "Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients". Journal of Emergency Medicine 33 (3): 265–71. doi:10.1016/j.jemermed.2007.02.030. PMID 17976554.
  6. Melniker LA; Leibner E; McKenney MG; Lopez P; Briggs WM; Mancuso CA (Sep 2006). "Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial". Annals of Emergency Medicine 48 (3): 227–35. doi:10.1016/j.annemergmed.2006.01.008. PMID 16934640.
  7. Ollerton JE; Sugrue M; Balogh Z; D'Amours SK; Giles A; Wyllie P (Apr 2006). "Prospective study to evaluate the influence of FAST on trauma patient management". Journal of Trauma 60 (4): 785–91. doi:10.1097/01.ta.0000214583.21492.e8. PMID 16612298.
  8. Miller MT; Pasquale MD; Bromberg WJ; Wasser TE; Cox J (Jan 2003). "Not so FAST". Journal of Trauma 54 (1): 52–60. doi:10.1097/00005373-200301000-00007. PMID 12544899.
  9. 9.0 9.1 Scalea T, Rodriguez A, Chiu W, Brenneman F, Fallon W, Kato K, McKenney M, Nerlich M, Ochsner M, Yoshii H (1999). "Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference". Journal of Trauma 46 (3): 466–72. PMID 10088853.

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