Pelvic (Suprapubic) View
The spaces examined in this view are the most dependent in a supine patient. They include the inferior paracolic gutters, the rectovesicular view (male) and the retrouterine, rectouterine and pouch of Douglas views (female). The bladder is used as a sonographic window, and therefore a full bladder is ideal. Images may be obtained with a partially-filled bladder, but there is a greater chance of missing smaller amounts of free fluid. The literature speaks of filling the bladder via a foley catheter, but this is rarely done in the trauma setting. With the transducer placed immediately cephalad to the pubic bone, the probe is swept through the full length of the bladder to observe the surrounding potential spaces. It is then rocked side to side to visualize the paracolic gutters lateral to the bladder. The probe should also be turned 90 degrees and swept across the bladder for another perspective. Since the fluid-filled bladder results in some posterior acoustic enhancement artifact, gain setting may need to be decreased for proper visualization of posterior spaces.
FAST Pathology!
References:
1. ACEP Policy Statement: Emergency Ultrasound Imaging Criteria Compendium (April 2006)
2. www.Trauma.org (November 2006)
3. Townsend: Sabiston Textbook of Surgery, 17th ed.
4. Ma/Mateer, Emergency Ultrasound, © 2003
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