Normal FAST - RUQ
No free fluid in Morrison's pouch.
Dr. Justin Bowra
Positive FAST - RUQ - Morrison's Pouch
Blunt trauma patient with POSITIVE FAST scan. The liver can been seen floating in free fluid with the kidney posteriorly. The fluid is in Morrison's pouch. Be sure to visualize the tip of the liver to complete the evaluation.
Dr. Justin Bowra
Positive FAST - RUQ
30 y/o pedestrian struck by car, hemodynamically unstable, tachycardic. FAST performed after primary survey revealed free fluid in all four abdominal views of the FAST exam
Free fluid in morrison’s pouch of the RUQ view. This is the most sensitive view to detect free fluid in trauma.
Dr. Catharine Bon - Kings County Emergency Medicine
Positive FAST - RUQ
Blunt trauma patient with POSITIVE FAST scan. The liver can been seen floating in fluid with adjacent bowel.
Dr. Justin Bowra
Positive FAST LUQ
30 y/o pedestrian struck by car, hemodynamically unstable, tachycardic. FAST performed after primary survey revealed free fluid in all four abdominal views of the FAST exam
Free fluid seen between the spleen and the diaphragm in this LUQ view.
Dr. Catharine Bon - Kings County Emergency Medicine
Normal FAST - LUQ
No free fluid is seen between the spleen and the diaphragm.
Dr. Justin Bowra
Positive FAST - LUQ
Blunt trauma patient with POSITIVE FAST scan. Free fluid can be seen between the spleen and the diaphragm in this LUQ view.
Dr. Justin Bowra
Normal FAST - Pelvis - Transverse
No free fluid is seen around or behind the bladder in this negative FAST.
Dr. Justin Bowra
Positive FAST Pelvis - Transverse
Blunt trauma patient with POSITIVE FAST scan. The uterus can been seen floating in free fluid.
Dr. Justin Bowra
Positive FAST - Pelvis Transverse
Blunt trauma patient with POSITIVE FAST scan. Free fluid can be seen posterior and lateral to the bladder in this sagittal view.
Dr. Justin Bowra
Normal FAST - Pelvis - Sagittal
No free fluid is seen behind the bladder in this sagital view.
Dr. Justin Bowra
Positive FAST - Pelvis
30 y/o pedestrian struck by car, hemodynamically unstable, tachycardic. FAST performed after primary survey revealed free fluid in all four abdominal views of the FAST exam.
Free fluid seen superior and posterior to the bladder in this sagittal view.
Dr. Catharine Bon - Kings County Emergency Medicine
Acute Traumatic Cardiac Tamponade
WCUME 2017 Submission for "Best POCUS"
Massive hemopericardium with coagulating blood and tamponade in a pediatric trauma patient. The patient went straight to the OR based on this image!
Dr. Sarah Medeiros - Sacramento, CA
Positive FAST - Pelvis - Sagittal
Blunt trauma patient with POSITIVE FAST scan. Free fluid can be seen posterior to the dome of bladder in this sagittal view.
Dr. Justin Bowra
Traumatic Pneumoperitoneum (1/2)
8 year old boy after pushbike handles went into abdomen. Erect CXR suggested small pneumoperitoneum.
Initial POCUS in supine position showed normal RUQ, however this clip in left lateral position shows a small 'bubble' of air between liver and abdominal wall.
Dr. Justin Bowra
Traumatic Pneumoperitoneum (2/2)
8 year old boy after pushbike handles went into abdomen. Erect CXR suggested small pneumoperitoneum.
This image shows a lung curtain across the liver.
Dr. Justin Bowra
Subxiphoid
The most superficial structure we see is the liver. Immediately deep to that we see the heart separated from the liver by the diaphragm. Closest to the liver is the right atrium, tricuspid valve, and right ventricle. Deeper to that, we see the left atrium, mitral valve, and left ventricle. There is no anechoic fluid between the bright hyperechoic pericardium and the myocardium, indicating absence of pericardial effusion.
Hannah Kopinksi and Dr. Lindsay Davis - NYU Emergency Medicine
Lung Slide
This is a clip demonstrating lung sliding. The most superficial hyperechoic layers are the soft tissue and muscular layers of the chest wall. Immediately deep to that is a bright, thin hyperechoic line which appears to be in motion - this is the pleural line. The parietal pleura rubbing against the visceral pleura as the patient breathes creates this shimmery appearance of lung sliding, also often described as “ants marching”. Lung sliding indicates that there is no pneumothorax.
Hannah Kopinksi and Dr. Lindsay Davis - NYU Emergency Medicine
Subcutaneous Emphysema
This patient fell 5m onto a slab of concrete. The curvilinear transducer was used for the EFAST survey of his left anterior chest wall
Hyperechoic irregular lines are seen superficial to the ribs (E lines - subcutaneous emphysema). These arise from air trapped in the soft tissue under the skin and should not be mistaken for the pleural line. Subcutaneous emphysema obscures the rib shadow and pleural line that lie below it
Learning point : the pleural line lies underneath the level of the ribs, subcutaneous emphysema lies above the level of the ribs
This patient had a large left-sided pneumothorax and an intercostal drain was placed followed by a serratus anterior plane block for analgesia
Dr. Cian McDermott - Dublin, Ireland
