{"id":5620,"date":"2021-03-08T12:51:15","date_gmt":"2021-03-08T17:51:15","guid":{"rendered":"https:\/\/todaysveterinarynurse.com\/?post_type=articles&p=5620"},"modified":"2022-09-07T15:19:26","modified_gmt":"2022-09-07T15:19:26","slug":"use-of-fast-ultrasonography-in-veterinary-emergency-rooms","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/radiology-imaging\/use-of-fast-ultrasonography-in-veterinary-emergency-rooms\/","title":{"rendered":"Use of FAST Ultrasonography in Veterinary Emergency Rooms"},"content":{"rendered":"

U<\/span>se of ultrasonography in veterinary <\/span>emergency and critical care situations continues to grow. Over the past 15 years, FAST scans have become integral diagnostic tools in veterinary emergency rooms. FAST scans enable emergency room clinicians to obtain vital information via ultrasound quickly, without the help of a radiologist.1<\/sup> FAST stands for F<\/b><\/span><\/span>ocused A<\/b><\/span><\/span>ssessment with S<\/b><\/span><\/span>onography for T<\/b><\/span><\/span>rauma and can be categorized as abdominal (AFAST) or thoracic (TFAST). A newer acronym, TFAST3 (for trauma, triage, and tracking), applies to extended use of the TFAST examination beyond trauma patients to include any patient who is at risk for pleural effusion, hemothorax, or pyothorax.1\u00a0<\/span><\/sup><\/p>\n

AFAST and TFAST can be performed by persons with minimal ultrasonographic experience. With proper training, veterinary nurses can perform the scanning without a veterinarian present, but only a veterinarian can make a diagnosis based on the images. No specific licenses or education beyond the veterinary license are required for veterinarians to perform FAST. Recommended training, however, includes hands-on training by a board-certified radiologist, reviewing FAST images, and performing a series of on-the-job scans witnessed by a more experienced practitioner. Short courses with wet labs are also available. Ideally, all of the training tools listed above will be utilized. A properly trained veterinary nurse who was present for the initial examination can keep the clinician updated as to the progression of free fluid and alert the doctor to any significant changes, but the final decision as to the patient\u2019s status and actions to be taken are, of course, up to the veterinarian.\u00a0<\/span><\/span><\/p>\n

Although FAST scans are especially useful, they are no substitute for a full examination by a board-certified radiologist. FAST scanning is often compromised by the situation of a busy emergency room: the lighting is usually too bright for optimal imaging, patients are often scared and painful, it may not be possible to place them in the proper position, and their abdomen may be tense. These factors combined with the skill level of the sonographer may affect accuracy of the assessment.<\/span><\/p>\n

FAST scans are noninvasive, quick (median AFAST scan time is 6 minutes2<\/sup>), and repeatable. They can be performed at the time of presentation, often while the initial physical examination is being performed, IV catheters are being placed, and other diagnostic or stabilizing procedures are being initiated.\u00a0<\/span><\/span><\/p>\n

AFAST and TFAST should be used to answer the following question: is there free fluid, pericardial effusion, or free air in the abdomen and\/or thorax? Any question as to tissue integrity or pathology of organ\/endocrine systems should be answered by a board-certified radiologist performing a full examination.<\/span><\/p>\n

An AFAST examination<\/b> is performed to look for free fluid, indicative of injury, within the peritoneal and retroperitoneal spaces. The significance of the AFAST study cannot be overstated. The leading cause of death in human trauma patients is undiagnosed intra-abdominal injuries, which are not always easily found at the time of initial presentation.2,3<\/sup> Use of AFAST can help expedite surgery for those who need it and decrease the number of exploratory laparotomies that reveal no abnormalities.<\/span><\/p>\n

Serial AFAST scans, when possible, are beneficial because subsequent scans may show fluid accumulation not detected on the initial scan.1<\/sup> Serial AFAST scans in conjunction with abdominal fluid scoring (AFS) can indicate changes in the quantity of abdominal fluid. AFS also has been shown to correlate well with the level of injury,1<\/sup> thereby helping guide the clinician\u2019s decisions as to what further diagnostics or stabilization are needed. A complete AFAST examines 4 sites (<\/span>BOX\u00a01<\/span><\/strong>). The AFS score reflects the number of sites with free fluid. For example, AFS 1 indicates 1 site with free fluid; AFS 4 indicates 4 sites with free fluid.<\/span><\/p>\n

BOX 1 The 4 Sites of an AFAST Examination (Performed in Left or Right Lateral Recumbency)<\/div>
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