Global FASTSM; AFAST~R, TFAST~R, and Vet BLUE~R for Patient Monitoring

摘要

The evolution of veterinary abbreviated ultrasound formats has extended beyond the abdominal format as a simple "flash exam" of fluid positive or fluid negative since the landmark publication by Boysen et al. in 2004. In 2008, the thoracic FAST formatwas developed by Lisciandro et al. and referred to as TFAST for the rapid diagnosis of pneumothorax and other thorax-related injury. In 2009, the abdominal FAST referred to as AFAST was a modification from the original FAST study. AFAST renamed the views with a target-organ approach rather than naming of external sites so that sonographer would be more aware anatomically about the actual organs and structures at each of the AFAST views; and AFAST directed the probe more strategically into the gravity-dependent regions of each view; and AFAST has its applied fluid scoring system to make more sense of a positive scan; and the same study advocated for 4-hour serial exams with repeat scoring for all hospitalized patients. In 2014, a 3rd abbreviated lung ultrasound format was published by Lisciandro et al. named Vet BLUE to complement AFAST and TFAST. In combination, these 3 formats are called Global FAST. Global FAST provides a huge amount of clinical information (<6-8 minutes) regarding your patient bytaking advantage of basic echo views of the heart, and non-echo views that reflect left- and right-sided cardiac status; and determining if your patient is losing volume internally because the abdominal cavity, retroperitoneal space, pleural cavity, pericardial sac, and lung are also surveyed for free fluid and edema, respectively; and urinary bladder volume may be estimated and serial exams using our AFAST cysto-colic formula can non-invasively estimate urine output. A similar strategy has evolved referred to as the rapid ultrasound in shock exam (RUSh) in emergent patients, although the RUSh exam does not have a fluid scoring system, lacks a lung screening component other than ruling in or out pneumothorax, and does not evaluate urinary bladder volume. Most recently, the analogous global approach as a screening test is gaining some momentum on the human side because focused exams are dangerous, and traditional complete abdominal ultrasound and complete echocardiography are often not in the right cavity. We advocate for a baseline Global FAST recorded on goal-directed templates for all admitted patients prior to intervention; and with proper training Global FAST takes <6-8 minutes with no shaving, minimal restraint.