Global FAST Exams Can Improve Patient Care for Your Small Animal Practice
As a veterinary internist who has been performing diagnostic abdominal ultrasounds and echocardiograms for the last 18 years, I was reluctant to understand the value of FAST exams in every day practice. However, for the past 9-10 years, I have been incorporating FAST techniques into my practice and I strongly believe that is has improved my patient care in ways that I did not expect. FAST stands for Focused Assessment of Sonography for Trauma but the techniques are not limited to trauma patients. Global FAST has been developed as an assessment tool to allow you to evaluate both the thoracic and abdominal cavities as well as lung. Obvious applications include the Triple T of Trauma, Triage (non-trauma), and Tracking (monitoring) of critically ill dogs and cats. However, I recommend using Global FAST every day as part of the physical exam in sick small animal patients, for pre-anesthetic screening, and as part of daily rounds in all hospitalized dogs and cats for monitoring both medical and surgical conditions. The importance of the whole body approach to point of care ultrasound was recently discussed in Chest, a human medical journal devoted to thoracic conditions:
“Critical care ultrasonography requires that all image acquisition, image interpretation, and clinical applications of ultrasonography are personally performed by the critical care clinician at the point of care and that the information obtained is combined with the history, physical, and laboratory information. Point-of-care ultrasonography is often compartmentalized such that the clinician will focus on one body system while performing the critical care ultrasonography examination. We suggest a change from this compartmentalized approach to a systematic whole-body ultrasonography approach.”
This case is a great example of how important Global FAST is to help you better manage patient care. An 11 year old M/N Beagle presented to his primary care veterinarian for a dental cleaning. His physical examination was considered normal including normal heart rate and respiratory rate and the owners did not note any changes in his behavior prior to the examination. The hospital has instituted Global FAST as a screening test for pre-anesthetic patients.
Global FAST showed the following:
Abdominal FAST (only significant findings listed):
DH View: Pericardial effusion is noted at the DH site. There is hepatic venous distention that supports right sided cardiac insufficiency (secondary to pericardial effusion). Two focal mass lesions are seen in the liver.
TFAST Left Pericardial view: Pericardial effusion is evident.
TFAST Right Pericardial long axis view: Large volume pericardial effusion is evident. There is a mass lesion at the heart base that measures approximately 2.0 cm in diameter.
This case illustrates several very important points.
Global FAST allowed the detection of a life threatening OCCULT disease process prior to a routine anesthetic procedure. Chronic pericardial effusion can be difficult to detect on the basis of physical examination. In this patient, heart rate and respiration rate were normal because pericardial effusion developed slowly allowing the patient to compensate.
Global FAST allows for the detection of thoracic conditions on the abdominal views. At the DH (diaphragmatic hepatic) view, the pleural and pericardial space can be examined. In addition, assessment of the caudal vena cava and hepatic veins allows for indirect assessment of right atrial pressure. Global FAST allows us to evaluate functional parameters in addition to structural changes.
Global FAST is performed in right lateral recumbency and standing and minimizes stress on your patient.