II. Approach: Suprapublic View (Pelvis)

  1. Transducer positioning
    1. Placement: Low suprapubic region
      1. Place probe immediately above suprapubic bone
    2. Axis: Long axis (longitudinal)
      1. Probe indicator at 12:00
      2. Longitudinal axis is best for visualizing anatomic landmarks (easiest for those new to Ultrasound)
    3. Probe Direction
      1. Perpendicular to Pelvis - towards low Lumbar Spine
    4. Gain
      1. Turn down gain to visualize structures behind the Bladder
  2. Landmarks (based on longitudinal axis with probe indicator at 12:00)
    1. Bladder and Bladder midline
      1. Draw a line through the midline of longitudinal Bladder view from screen top to screen bottom
      2. Superior to line (screen left)
        1. Free fluid and blood collects here, deep to Bladder (this region should be key focus)
        2. Men collect flud immediately deep to Bladder
        3. Women collect fluid deep to Uterus (deep to Bladder), in Pouch of Douglas
      3. Inferior to line (screen right)
        1. Represents low Pelvis structures (e.g Prostate)
        2. Region of little concern in the trauma Ultrasound
    2. Uterus
      1. Blood and fluid typically collects deep to the Uterus (pouch of douglas)
        1. Does not collect between the Bladder and Uterus
      2. Structures
        1. Cervix lies deep to lowest point of Bladder
        2. Vagina is inferior (screen right), just deep to Bladder
        3. Uterus is superior (screen left), just deep to Bladder
  3. Conditions
    1. Blood in Pelvis (Douglas Pouch)
      1. Focus on longitudinal midline view
        1. Blood will appear as a dark black collection, superior to Bladder (screen left)
        2. Blood (or fluid) will outline omentum appearing as irregular shapes
        3. Contrast with normal suprapubic region appearance (gray, hazy, partially hypoechoic)
      2. Perform initially prior to Foley Catheter insertion (Bladder should be full to start)
        1. Full Bladder provides acoustic window for deeper structures (e.g. Uterus)
      3. May be difficult to distinguish Bladder from blood in Pelvis
      4. Consider re-scanning after urine drained with Foley Catheter
    2. Younger children
      1. May be more sensitive than Morrison's Pouch for intraabdominal blood
    3. Males
      1. Any free fluid is abnormal
    4. Women
      1. Free fluid seen on transabdominal Ultrasound is not typically physiologic
        1. Contrast with Transvaginal Ultrasound which is sensitive enough to find trace fluid
  4. Images: Long Axis
    1. ultrasoundProbePositionLungFASTsupraPubicLong.jpg
    2. ultrasoundBMP_abdBladder_lax.jpg
  5. Images: Short Axis
    1. ultrasoundProbePositionLungFASTsupraPubicShort.jpg
    2. ultrasoundBMP_abdBladder_sax.jpg

III. Resources

IV. References

  1. Reardon (2016) FAST Scan, Online Video Stabroom.com, accessed 4/1/2016
  2. Reardon (2013) Emergency Ultrasound Course, 3rd Rock Ultrasound, Minneapolis, MN
  3. Alameda County Trauma Service FAST Exam
    1. http://eastbay.surgery.ucsf.edu/eastbaytrauma/Protocols/ER%20protocol%20pages/FAST-files/FAST.htm
  4. Mateer (2012) Introduction to Trauma Ultrasound Video, GulfCoast Ultrasound, VL-95-T
    1. https://www.gcus.com/products/about.asp?product=338/Introduction-to-Trauma-Ultrasound
  5. HCMC FAST Exam
    1. http://vimeo.com/1044031

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