Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York City, New York, USA.
Reg Anesth Pain Med. 2019 May;44(5):540-548. doi: 10.1136/rapm-2018-100312. Epub 2019 Mar 21.
This article in our point-of-care ultrasound (PoCUS) series is dedicated to the role the focused assessment with sonography in trauma (FAST) exam plays for the regional anesthesiologist and pain specialists in the perioperative setting. The FAST exam is a well-established and extensively studied PoCUS exam in both surgical and emergency medicine literature with over 20 years demonstrating its benefit in identifying the presence of free fluid in the abdomen following trauma. However, only recently has the FAST exam been shown to be beneficial to the anesthesiologist in the perioperative setting as a means to identify the extravasation of free fluid into the abdomen from the hip joint following hip arthroscopy. In this article, we will describe how to obtain the basic FAST views (subcostal four-chamber view, perihepatic right upper quadrant view, perisplenic left upper quadrant view, and pelvic view in the longitudinal and short axis) as well as cover the relevant sonoanatomy. We will describe pathological findings seen with the FAST exam, primarily free fluid in the peritoneal space as well as in the pericardial sac. As is the case with any PoCUS skill, the application evolves with understanding and utilization by new clinical specialties. Although this article will provide clinical examples of where the FAST exam is beneficial to the regional anesthesiologist and pain specialist, it also serves as an introduction to this powerful PoCUS skill in order to encourage clinical practitioners to expand the application of the FAST exam within the scope of regional anesthesia and pain management practice.
这是我们的即时超声系列文章中的一篇，专门介绍了创伤重点评估超声（FAST）检查在围手术期对区域麻醉师和疼痛专家的作用。FAST 检查是一项在外科和急诊医学文献中都有充分研究和广泛应用的成熟超声检查，超过 20 年的研究证明了它在识别创伤后腹部游离液体方面的益处。然而，直到最近，FAST 检查才被证明对围手术期的麻醉师有益，可以作为一种手段，识别髋关节镜检查后髋关节游离液体漏入腹部。在本文中，我们将描述如何获得基本的 FAST 视图（肋缘下四腔视图、肝周右上象限视图、脾周左上象限视图以及纵向和短轴盆腔视图），并涵盖相关的超声解剖。我们将描述 FAST 检查中所见的病理发现，主要是腹膜腔内和心包腔内的游离液体。与任何即时超声技能一样，其应用随着新临床专业的理解和使用而发展。尽管本文将提供 FAST 检查对区域麻醉师和疼痛专家有益的临床实例，但它也是对这一强大即时超声技能的介绍，以鼓励临床医生在区域麻醉和疼痛管理实践范围内扩展 FAST 检查的应用。
