Identifying a pelvic free fluid on FAST exam in a patient following a motorcycle crash. Their patient is a 24 yo female who was involved in a motorcycle accident. Initially, the patient was normotensive with a heart rate in the 80s. Views in the LUQ and RUQ did not initially show obvious free fluid. In the sagittal view of the pelvis, shown below, there is a collection of free fluid posterior to the bladder. The fluid is not completely anechoic (black) - this is sometimes seen with blood. To get this image the probe is placed just above the pubic symphysis with the indicator marker pointed towards the head. To visualize structures posterior to the bladder you will often need to rock the probe so you are pointing into the pelvis.
Image 1
The RUQ is typically our most sensitive view, but in most children and in patients who are sitting somewhat upright the pelvis will often be positive first. Remember, not all patients with a positive FAST will require the OR. Those with normal vitals will require close monitoring and prompt surgical consultation. Given her stable vitals, this patient had a CT scan performed that showed a grade IV liver laceration as the source of her bleeding. She was admitted to the ICU and did well with observation alone. Her CT scan is shown below.
Image 2
Date: September 2013
Image credit: Drs. Numur and Siegelman