Shadowing Practice: FAST Exam: Focused Assessment with Sonography in Trauma - Learn English Speaking with Video
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Hello, everyone.
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My name is Dr. Aidan Sharkey.
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I'm an attending anesthesiologist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, and today we're going to be discussing the FAST exam.
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The key takeaways of today's lecture are to firstly discuss the indications and limitations of performing the FAST exam, secondly to discuss the equipment required,
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and finally we'll go through some basic views involved in performing the FAST exam.
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To begin let us first define what exactly a FAST exam is.
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FAST stands for Focus Assessment with Sonography and Trauma
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and this is a rapid assessment done at the bedside for trauma patients in order to diagnose and guide therapy.
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With the FAST exam we are assessing for free fluid which would indicate visceral injury in four key regions,
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peri -hepatic, perisplenic, pericardium, and suprapubic areas.
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The indications for performing a FAST exam are very broad, and its use should be considered in all abdominal and or thoracic trauma situations,
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where the mechanism of injury is blunt or penetrating in nature.
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Patients presenting with undifferentiated hypotension or shock should also undergo a FAST exam as part of their workup.
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With respect to the limitations of performing a FAST exam, there are no absolute contraindications.
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However, the exam should not delay treatment of unstable patients, and the operator should be aware of the limited sensitivity of a negative exam.
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Therefore, an unstable patient with a negative FAST exam or a patient in
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which there is a high index of suspicion for visceral injury
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should undergo further testing in the form of a CT scan or operative assessment.
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In terms of equipment required for performing a FAST exam, you will need access to an ultrasound machine and the correct ultrasound probe.
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For abdominal scans, we generally choose the curvilinear probe, which is a probe with a low frequency resulting in increased depth of penetration.
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Alternatively, the phased array probe, which is also a low frequency probe, can also be utilized as part of the FAST exam.
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It is important to note the location of the indicator marker on the probe
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and which side of the image this corresponds to when looking at the screen.
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For the curvilinear probe, this is generally on the left of the screen.
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And for the phased array probe, this is on the right of the screen.
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Moving on to performing the FAST exam, and this is performed by examining four areas for the presence of free fluid.
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that is the right upper quadrant for fluid in the peri
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-hepatic space left upper quadrant for fluid in the perisplenic space subcostal area for pericardial fluid
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and finally the pelvic area for suprapubic fluid we will now go through each of these views
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and discuss how each view is obtained
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and look at some sonoanatomy the right upper quadrant
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or peri -hepatic view is used to assess for free fluid in the space between the liver and the right kidney.
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To obtain this view, we place the probe in the mid -axillary line on the right side between the 8th
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and 11th intercostal space.
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The indicator should be facing towards the 12 o 'clock position or the patient's head.
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This view is most useful for the assessment of free fluid in the peri -epatic space, also known as Morrison's pouch, as depicted in this image.
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This example depicts fluid in the peri -hepatic space as indicated by the yellow arrows.
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An image such as this is very concerning for a visceral injury.
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Moving on to the left upper quadrant or perisplenic view.
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This view is used to assess for free fluid around the left kidney and spleen.
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To obtain this view we place the probe in the mid
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-auxiliary line on the left side between the 8th to 11th
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intercostal space with the indicator again facing towards the 12 o 'clock position or patient's head.
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As anatomically the spleen is a very posterior structure, the probe will also need to be in a very posterior position in order to obtain this view.
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In this view, the structures identified include the spleen to the left of the screen, the left kidney to the right of the screen, and the diaphragm to the bottom of the screen.
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Sliding between intercostal spaces may again be required to optimize this view.
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In this view, we are looking for free fluid accumulation in two spaces the perisplenic space between the spleen
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and the diaphragm as indicated by the green line
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and the splenorenal space between the spleen and the left kidney as indicated by the yellow line
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free fluid will preferentially be located in the perisplenic space
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or into the presence of the splenorenal ligament
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which limits the ability of fluid to track in between the spleen
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and the left kidney in this image we see free fluid as indicated by the yellow arrows surrounding the space.
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To obtain the subcostal view, we place the probe just inferior to the xiphoid process.
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If we are using the curvilinear probe, we have the indicator facing to the patient's right.
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However, if we are using the phased array probe, we have the indicator facing to the patient's left.
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It is often helpful to have the patient bend their knees and take a breath in to optimize this view.
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And also the ultrasound probe should be aligned slightly anteriorly.
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In this view, we should be able to identify the liver, pericardium, and the two atria and two ventricles of the heart as depicted in this video loop.
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This view is particularly useful for evaluating for free fluid in the pericardial space, as seen in these videos depicted by the yellow arrows.
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Both video clips demonstrate circumferential fluid collection.
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The video to the right of the screen additionally depicts one of the distinguishing features suggesting possible tamponade physiology,
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that is right ventricular diastolic collapse.
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Finally, the pelvic scan will assess for fluid in the suprapubic region.
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To obtain this view, we place the probe right above the pubic symphysis with the indicator probe facing to the patient's right.
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Ideally, the patient would have a full bladder
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so as to act as an acoustic window
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and then the probe should be tilted caudally so as to scan deep into the pelvic cavity.
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In this view, we should be able to identify the bladder, prostate and rectum in males and in females the bladder,
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uterus and rectum should be seen. In males,
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fluid tends to accumulate in the recto for cycle pouch whereas in females fluid collects in the recto uterine pouch
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which is also known as the pouch of Douglas.
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In this example, we can see free fluid accumulating in the recto uterine pouch, as indicated by the yellow arrows,
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possibly indicating a ruptured ectopic pregnancy in this patient.
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That concludes our lecture on the FAST exam today.
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In summary, we went through the four basic U's to perform a FAST exam, along with highlighting both normal and abnormal anatomy associated with these views.
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Thank you for watching, and I hope you found this topic helpful.
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Vocabulary and speaking notes for this lesson
This speaking lesson is built on the video “FAST Exam: Focused Assessment with Sonography in Trauma”. The speaker keeps coming back to these words: fluid, view, probe, exam, Fast. This video has 61 sentences and 1167 words to shadow. The speech runs for 7:28. The speaker talks at a natural 156 words per minute, close to everyday conversation. Only 72% of the words are among the 3,000 most common in English, so the vocabulary is demanding.
Key vocabulary in this video
15 words from the video worth learning, with pronunciation and meaning:
| Word | Pronunciation | Meaning |
|---|---|---|
| fluid noun | /ˈflu.ɪd/ | Any substance which can flow with relative ease, tends to assume the shape of its container, and obeys Bernoulli's principle; a liquid, gas or plasma. |
| probe noun | /pɹoʊb/ | Any of various medical instruments used to explore wounds, organs, etc. |
| examination noun | /ɪɡˌzæm.ɪˈneɪ.ʃən/ | The act of examining. |
| indicate verb | /ˈɪndɪˌkeɪt/ | To point out; to discover; to direct to a knowledge of; to show; to make known. |
| obtain verb | /əbˈteɪn/ | To get hold of; to gain possession of, to procure; to acquire, in any way. |
| indicator noun | /ˈɪn.dɪˌkeɪ.tə(ɹ)/ | A pointer or index that indicates something. |
| kidney noun | /ˈkɪdni/ | An organ in the body that filters the blood, producing urine. |
| assessment noun | /əˈsɛsmənt/ | The act of assessing or an amount (of tax, levy or duty etc) assessed. |
| arrow noun | /ˈæɹəʊ/ | A projectile consisting of a shaft, a point and a tail with stabilizing fins that is shot from a bow. |
| assess verb | /əˈsɛs/ | To determine, estimate or judge the value of; to evaluate; to estimate. |
| scan verb | /skæn/ | To examine sequentially, carefully, or critically; to scrutinize; to behold closely. |
| trauma noun | /ˈtɹɔm.ə/ | Any injury to the body of a living thing. |
| array noun | /əˈɹeɪ/ | Clothing and ornamentation; raiment. |
| bladder noun | /ˈblædɚ/ | A flexible sac that can expand and contract and that holds liquids or gases. |
| ultrasound noun | /ʌl.tɹə.saʊnd/ | Sound with a frequency greater than the upper limit of human hearing, which is approximately 20 kilohertz. |
Phrasal verbs you will hear
| Word | Meaning |
|---|---|
| go through verb | To travel from one end of something to the other. |
דקדוק בסרטון הזה
המבנים שהדובר משתמש בהם הכי הרבה, עם המילים המדויקות מהסרטון:
| מבנה | בסרטון |
|---|---|
| סביל (Passive voice) be + past participle — הדגש הוא על מה שקורה, לא על מי שעושה את הפעולה | should be considered · be utilized · is performed |
| משפטי זיקה (Relative clauses) who / which + clause — מידע נוסף על אדם או דבר | probe, which is |
Pronunciation to watch
The speaker uses 3 contractions and reduced forms, such as I'm, we'll, we're. Say them the short way, as you hear them.
- The “th” sounds: breathe /bɹiːð/, thoracic /θəˈɹæsɪk/
- The “sh” and “zh” sounds: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indication /ɪndɪˈkeɪʃən/, limitation /lɪmɪˈteɪʃən/, shock /ʃɔk/, associate /əˈsoʊʃi.ət/
- Long words — get the stress right: examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, indicator /ˈɪn.dɪˌkeɪ.tə(ɹ)/, indication /ɪndɪˈkeɪʃən/, anatomy /əˈnætəmi/, auxiliary /ɔɡˈzɪl.(jə).ɹi/
How to practise with this video
- Listen to the whole video once without speaking and note the words you do not know.
- Start at 0.75× speed, shadow it sentence by sentence, then go back to normal speed once it feels easy.
- Record yourself and compare with the original, paying attention to words like fluid, probe, examination.
מהי טכניקת השאדואינג?
שאדואינג היא טכניקת למידת שפה מבוססת מדע שפותחה במקור להכשרת מתורגמנים מקצועיים ופופולרית על ידי הפוליגלוט ד"ר אלכסנדר ארגואלס. השיטה פשוטה אך עוצמתית: אתה מקשיב לאודיו באנגלית ילידית וחוזר עליו בקול רם מיד — כמו צל העוקב אחרי הדובר עם עיכוב של 1–2 שניות בלבד. בניגוד להאזנה פסיבית או תרגילי דקדוק, שאדואינג מכריח את המוח והשרירים בפה לעבד ולשחזר דפוסי דיבור אמיתיים בו זמנית. מחקרים מראים שזה משפר משמעותית את דיוק ההגייה, האינטונציה, הקצב, הדיבור המחובר, הבנת השמיעה ושטף הדיבור — מה שהופך אותו לאחת השיטות היעילות ביותר להכנה לIELTS Speaking ולתקשורת באנגלית בעולם האמיתי.