FAST_Final (1)

Transcript

• 00:15So, when I do a
• 00:17fast, I usually start with
• 00:18a right upper quadrant view,
• 00:19and I like to start
• 00:20in the anterior humeral line,
• 00:22looking for a rib space,
• 00:24and
• 00:26and looking again. We're gonna
• 00:27illustrate a couple of different
• 00:28movements. One is this is
• 00:30so called rocking, looking securely
• 00:33and inferiorly, and this is
• 00:34called fanning, looking anteriorly and
• 00:36posteriorly
• 00:37and rotating sometimes if you
• 00:39need to get between two
• 00:40ribs, but this is a
• 00:42pretty good image. Then I'm
• 00:43sliding up and down to
• 00:44the inferior pole of the
• 00:45right kidney.
• 00:47So that's a complete ride
• 00:49of the car.
• 00:59The next view, since we're
• 01:00in the territory, we can
• 01:01do the subdiphoid
• 01:03view. Again, you're putting the
• 01:04transducer
• 01:05in the subdiphoid region
• 01:07aiming up. Sometimes it's easier
• 01:09to put the hand on
• 01:09top of the transducer
• 01:11and then aim up. And
• 01:12then Antonio is gonna help
• 01:13me change the depth so
• 01:14that
• 01:15it fills the heart.
• 01:19Again, you might find this
• 01:20difficult in a skinny patient.
• 01:23It's very difficult to get
• 01:24a very good window. We'll
• 01:25show you on the cardiac
• 01:26piece where you can get
• 01:27a pressure on a long
• 01:28axis, which looks very similar
• 01:29to this view.
• 01:38The next view we look
• 01:39at is a left upper
• 01:40quadrant view where you can
• 01:41put your hand really almost
• 01:42at the at the bottom
• 01:44of the bed.
• 01:47Looking at the spleen.
• 01:49Again, you're gonna be fanning
• 01:50to look more anteriorly, that
• 01:52stomach full of snack after
• 01:53school.
• 01:54Looking close to your lead
• 01:56fanning, that gets you the
• 01:57left kidney and sliding up
• 01:59to see the the rib
• 02:00shadow or the diaphragm and
• 02:02sliding down to see the
• 02:04inferior pull of the left
• 02:05kidney.
• 02:06A reverberation artifact. Do you
• 02:08have metal in your rib
• 02:09today?
• 02:10I don't know. Some hydronelchros
• 02:12or Joshua's.
• 02:13That's a psoas muscle.
• 02:22Supapupic view. Again, you wanna
• 02:24put the transducer right over
• 02:26the pubic symphysis, which is
• 02:27right here.
• 02:28And then
• 02:30looking transversely first,
• 02:33any blood in any free
• 02:37any free fluid will collect
• 02:39behind the bladder,
• 02:41either the transverse or the
• 02:44sagittal view, then you rotate
• 02:45the transducer with indicator towards
• 02:46the head of the patient.
• 02:48Again, the free fluid will
• 02:49be behind
• 02:50in the cul de sac
• 02:51in the female pigeon and
• 02:53behind the bladder in the
• 02:54male
• 03:02Remember,
• 03:03the FAST examination,
• 03:04you are looking for an
• 03:05answer to the question, do
• 03:07I see free fluid? Yes
• 03:08or no?
• 03:10It is either positive or
• 03:11negative.
• 03:12It is not designed
• 03:13to tell you where the
• 03:15fluid is leaking from or
• 03:17why the patient is bleeding
• 03:18in the first place.
• 03:20Fluid? Yes, no is the
• 03:22question we will answer.
• 03:36This is what a pericardial
• 03:38effusion would look like. You
• 03:39can see how the heart
• 03:41seems pushed to the side
• 03:42by a large amount of
• 03:43fluid.
• 03:44This is a positive fast.
• 03:46Although, the v obtained in
• 03:48this case is a parasternal
• 03:50long axis and not typically
• 03:51part of the fast.
• 03:53We just wanted to show
• 03:54you what a large pericardial
• 03:56effusion
• 03:57would look like.
• 04:10You will see the liver
• 04:12closest to the transducer and
• 04:14then the kidneys.
• 04:16This is a positive or
• 04:17negative fast.
• 04:21As you can see, there
• 04:22is fluid in the Morrison's
• 04:23pouch, so this fast is
• 04:25positive.
• 04:26The CT scan on the
• 04:27right shows you an intra
• 04:29abdominal fluid collection confirming that
• 04:31you were right.
• 04:34Here you can see a
• 04:35very small dark line between
• 04:37the liver and kidney.
• 04:38It may be small, but
• 04:39still counts as positive. Remember,
• 04:42a fast is either positive
• 04:44or negative, not a little
• 04:45bit positive.
• 04:59Is this positive or negative?
• 05:02Yes. You know it. There
• 05:04is fluid between the diaphragm
• 05:05and the spleen. It is
• 05:07positive.
• 05:08Positive or negative?
• 05:12Yep. You know it. It
• 05:13is positive. There is a
• 05:14small fluid collection.
• 05:39Here you can see free
• 05:40fluid behind the bladder representing
• 05:42a positive FAST examination.
• 05:45As you can see on
• 05:46the picture on the right,
• 05:47it was confirmed by a
• 05:49CT scan.
• 05:51Alright. Ready for some cases?
• 05:53I want you to first
• 05:54name the view and second,
• 05:56point out the pathology.
• 05:58Let's go.
• 06:05Yes. You're right. We used
• 06:07a curvilinear probe
• 06:08and this is the right
• 06:10upper quadrant view.
• 06:11The fast is positive. You
• 06:13can clearly see free fluid
• 06:14on the left lobe of
• 06:15the liver
• 06:17and at Morrison's pouch.
• 06:19Ready for the next one?
• 06:27Good job.
• 06:28We were using a curvilinear
• 06:30probe, and this is the
• 06:31right upper quadrant view. It
• 06:33is positive because there is
• 06:34a tiny amount of free
• 06:36fluid at the inferior pole
• 06:38of the spleen.
• 06:40Okay. Advance to the next
• 06:41slide. Take your time.
• 06:55Yes. We used a curvilinear
• 06:57probe, and we're looking at
• 06:59the right pleural space.
• 07:01You correctly identified the pleural
• 07:03effusion.
• 07:04We will cover the lung
• 07:06and pleural pathologies
• 07:07in a separate lecture though.
• 07:09Next case.
• 07:17We used a curvilinear probe
• 07:19and this was a pelvic
• 07:20view. It is positive for
• 07:22free fluid.
• 07:24Remember in pediatric cases most
• 07:26positive fast scans
• 07:28are seen on pelvic views.
• 07:31In contrast with adults, whether
• 07:33Morrison's pouch view is the
• 07:35most commonly positive.
• 07:37Strong work. One last case
• 07:38and you're done.
• 07:47Perfect.
• 07:48We used a phased array
• 07:49transducer
• 07:50and this was a subside
• 07:51fluid view.
• 07:53There's a large pericardial effusion.