SonoTip&Trick: “I can’t get a good RUQ view for my FAST!” – Really? Well, try this…

The “F” in FAST does not mean “fast”; it stands for “focused”. The good thing is that everyone agrees to that, but we so often forget. This week has turned into the right upper quadrant (RUQ) view of the FAST week! I actually don’t mind that at all and I love it – as too many incomplete FAST scans are done (and accepted). It’s tragic, actually. I get it, and I’ve been there – you feel rushed because you either have too many patients to see, others need the ultrasound machine, or your consultants or surgeons are yelling at you to hurry up because they want to roll the patient or get that life-saving chest radiograph (don’t get me started!). It needs to be a complete, deliberate, and dedicated study. You should know when and how to do the FAST, especially the RUQ as it is one of the most accurate, and how to do it well. After having shown you several cases and images of real patients, some (including me) still have a hard time getting the perfect views of each of the sections of the RUQ (yes, there are “sections” of the RUQ) even though everything is done the right way. Well, thankfully, there are some little tricks to improve your image quality  - so that you feel confident about telling that consultant the FAST results with your voice confident, back straight, chest out and shoulders back. You may even want to add a “booya” at the end of it.

SonoTip&Trick: There’s a left pneumothorax! Really? check again…

Whenever you are performing an E-FAST exam on your trauma patient or a thoracic US in those with unexplained shock or shortness of breath, your sphincter tightens when you see fluid in the belly or when there is no lung sliding. Ever placed your probe on the left anterior chest wall and have been surprised after noticing there is no lung sliding? Or, that you see this weird movement of “the lung” on the left side, which surely isn’t normal and definitely deeper than the pleural line and you think, “There’s a left pneumothorax!” Well, guess what guys and gals, it just could be the heart.

SonoTip&Trick: “I can never get a nice subxiphoid view!” Really? Well try this…

You get a patient who has gradual onset of shortness of breath with a history of cancer, a patient with sudden severe exertional chest pressure and new orthopnea, a patient with known pericarditis with worse pain or breathing difficulty, or a trauma patient with a penetrating stab wound to the chest and you want to evaluate whether they have a pericardial effusion, signs of tamponade, or poor contractility through a bedside echo, but you just can’t seem to obtain a great subxiphoid (SX) view. The SX view of the heart seems like it would be easy to obtain. I mean, it is right there! – right by the probe, and the patient is alive so you know he has a heart! Well, sometimes it’s not so easy. There are several reasons for this: your probe positioning, not seeing the liver, and the patient’s thoracic cage.

SonoTip: Da Spine Sign: Dont miss that Pleural Effusion on the FAST scan!

I call it “Da Spine Sign” (insert any accent here – trust me, its funny). So, fluid is the lover of ultrasound, right? And air is the enemy. Typically you will not see the spine passed the diaphragm when looking at your RUQ view for your FAST scan in normal patients, but oh when you do, BAM! You know there’s fluid in the thorax. Here’s an image showing exactly that, as well as a little somethin’ somethin’ in the intraperitoneal space… so, don’t forget to look above the diaphragm in your FAST scan views! By the way – it’s also called the V-Line - I like my name better