Which of the following is the correct sequence of abdominal regions assessed during the FAST examination in blunt abdominal trauma?

Explanation

## FAST Examination Sequence **Key Point:** The standard FAST (Focused Assessment with Sonography for Trauma) examination follows a systematic four-view protocol in a specific order to maximize diagnostic accuracy and efficiency. ### Standard FAST Protocol Order 1. **Pericardial view** — assess for hemopericardium (cardiac tamponade risk) 2. **Perihepatic (Morrison's pouch)** — most common site of free fluid in blunt trauma 3. **Perisplenic** — left upper quadrant assessment 4. **Pelvic** — suprapubic view for pelvic free fluid **High-Yield:** The pericardial view is performed FIRST because hemopericardium indicating cardiac tamponade is immediately life-threatening and requires urgent intervention (pericardiocentesis or resuscitative thoracotomy). The perihepatic view is most sensitive for detecting intra-abdominal free fluid because the right paracolic gutter and Morrison's pouch are dependent areas. ### Why This Order Matters | View | Primary Purpose | Clinical Significance | |------|-----------------|----------------------| | Pericardial | Detect hemopericardium | Life-threatening if positive | | Perihepatic | Detect hemoperitoneum | Most sensitive location | | Perisplenic | Detect left-sided bleeding | Assess splenic injury | | Pelvic | Detect pelvic bleeding | High mortality if positive | **Clinical Pearl:** A positive FAST (free fluid in any view) in the setting of hemodynamic instability mandates urgent laparotomy. The absence of free fluid does NOT exclude significant intra-abdominal injury, particularly solid organ injuries without active bleeding. **Mnemonic:** **PPP-P** = **P**ericardial first (life threat), **P**erihepatic (Morrison's), **P**erisplenic, **P**elvic last.