FAST Ultrasound Scan Probe Positioning | Transducer Placement USG | Chest/Substernal/RUQ/LUQ Views

FAST Ultrasound Scan Probe Positioning | Transducer Placement USG | Chest/Substernal/RUQ/LUQ Views

*Cases:
Intro - 0:00
Substernal - Heart - 0:09
Right Upper Quadrant - 2:56
Right Paracolic Gutter Space - 4:00
Left Upper Quadrant - 5:13
Pelvis - 6:18
Lung - 8:53

Substernal - Heart:
- Position the probe transversely in the upper abdomen along the midline, and then tilt it upwards, aiming towards the patient's head, to scan the area beneath the costal margin.
- Examine the heart chambers, identifying the right ventricle as it appears more towards the top of the screen and has a more elongated shape compared to the left ventricle. Modify the depth and field of view (FOV) as needed. Position the focal zone at the midpoint of the left ventricle.
- Utilize the available acoustic windows to examine as much of the heart as possible, focusing especially on the surrounding area where any present pericardial effusion would be visible.

Right Upper Quadrant - Morrison’s Pouch:
- Position the probe longitudinally in the right upper quadrant (RUQ) to simultaneously capture images of the right kidney and the right lobe of the liver. Move the probe across one of the lower intercostal spaces to obtain a favorable acoustic window.

Right Paracolic Gutter Space:
- Place the probe longitudinally on the right side of the abdomen, in line with the right flank, just lateral to the ascending colon, roughly between the right costal margin and the iliac crest.
- Angle the probe medially (toward the patient's spine) and slightly cephalad (toward the patient's head) to visualize the area between the right kidney and the liver or right kidney and right colonic wall. Adjust the depth and gain as needed to obtain clear images.
- Slowly sweep the probe along the area, paying attention to the potential spaces where fluid might collect. Look for any anechoic (black) or hypoechoic (dark) areas, which might suggest the presence of free fluid.

Left Upper Quadrant:
- Position the probe longitudinally in the left upper quadrant (LUQ) to simultaneously visualize the left kidney and spleen. To obtain a suitable acoustic window, it might be required to scan across one of the lower intercostal spaces.

Pelvis (Male/Female):
- Place the probe in the suprapubic region, transversely, with the orientation marker directed to the patient's right. Look for the bladder, which may be largely collapsed, and assess the area around it for free fluid.Modify the depth and field of view (FOV) to target the region directly behind the bladder. In women, this will be the area where the uterus is located posteriorly to the bladder, requiring examination of the rectouterine pouch (also known as the pouch of Douglas).
- In men, the assessment should be of the rectovesical pouch. Be attentive to any fluid presence in the pouch of Douglas in females or the rectovesical pouch in males.
- Rotate the probe 90 degrees from the transverse position to the sagittal orientation, with the orientation marker directed towards the patient's head. Scan the pelvis sagittally, focusing on the uterus and the areas behind it. You may need to move the probe slightly to the left or right of the midline to get the best view.
- Rotate the probe 90 degrees from the transverse position to the sagittal orientation, with the orientation marker directed towards the patient's head. Scan the pelvis sagittally, focusing on the bladder and the areas behind it. You may need to move the probe slightly to the left or right of the midline to get the best view.

Lung - eFAST (Extended FAST) Scan:
- Start at the second or third intercostal space in the midclavicular line on the right side. The indicator on the probe should be directed towards the patient's head (marker to the head).
- Place the probe perpendicular to the ribs. You will see the ribs as hyperechoic (bright) lines with an acoustic shadow beneath them. Between the ribs, the pleural line appears as another bright, horizontal line. The area above this line is the chest wall, and the area below is the lung.
- Move the probe caudally and laterally to check different intercostal spaces. You are looking for the sliding sign (also known as lung sliding), which is the to-and-fro movement of the pleural line with respiration, indicating that the visceral and parietal pleurae are in contact. Its absence can suggest pneumothorax.
- After completing the right side, move to the left and repeat the process starting from the second or third intercostal space in the midclavicular line.

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