Vet360 Vet360 Vol 05 Issue 04 - Page 11

Article reprinted with permission of DVM360 – June 30, 2015. DVM360 MAGAZINE is a copyrighted publication of Advanstar Communications inc. All rights reserved Figure 2: The four areas evaluated on the FAST technique: diaphragmatic-hepatic (DH), spleno-renal (SR), cysto-colic (CC) and hepato-renal (HR). lateral recumbency to evaluate four specific sites within the abdomen (Figure 2): 1. Diaphragmatic-hepatic (DH) Figure 1: A radiograph from a 8.5-year-old spayed female English springer spaniel. Note the mild gas and fluid dilation of the stomach. The small bowel appears empty to mildly thickened or mildly fluid dilated. There is moderate remodeling of both hips with thickened femoral necks. Diagnostic impressions: Increased fluid in the stomach may be due to gastritis or pancreatitis. There is no evidence of foreign material or obstruction. Incidental moderate chronic hip arthritis is present. become so important in both human and veterinary medicine? There are clear limitations and concerns when moving a critically ill patient to radiology where it needs to be taped, sand-bagged or manually restrained to obtain diagnostic imaging results. Human and veterinary studies have demonstrated that radiographic serosal detail is not sensitive or specific at detecting abdominal fluid after blunt trauma (Figure 1). 1,2 2. Spleno-renal (SR) 3. Cysto-colic (CC) 4. Hepato-renal (HR) The sites are evaluated in a clockwise motion as you look for evidence of effusion, which is typically identified as anechoic (black) areas around the identified organ structures (Figure 3). Remember, this is a quick and dirty evaluation. Shaving the patient is not required. A little alcohol or ultrasound gel is sufficient, although it is important to remember to avoid alcohol if the patient is critical and may require defibrillation (or has injuries including abrasions or lacerations). Ultrasonography is thought to be a more ideal initial imaging modality as it can be performed simultaneously while other assessments are being performed and while resuscitative measures are provided. Importantly, there is no requirement to be a fancy board-certified radiologist to perform the ultrasound procedure. Non-radiologist veterinarians can be quickly trained to performed the AFAST 3 ultrasound to make life-saving clinical decisions. How does it work? Now that I have your attention and before you head to eBay for an ultrasound machine, let’s discuss how to perform the AFAST3. The patient is placed in right Figure 3: An ultrasonogram from a 10-year-old spayed female American bulldog. Multiple hypoechoic masses are seen throughout the liver measuring 1 to 4 cm. Mild effusion is present, seen here with an anechoic appearance. Issue 04 | SEPTEMBER 2018 | 11