Global Focused Assessment with Sonography for Trauma (Global FAST) combines Abdominal FAST (AFAST), Thoracic FAST (TFAST), and Vet BLUE into a single 15-data-point point-of-care ultrasound examination performed as an extension of the physical examination. This standardized, unbiased approach prevents the two most common interpretation errors in selective imaging: satisfaction of search error and confirmation bias error. Veterinary Clin…
AFAST uses 5 acoustic windows across the abdomen and serves as a rapid screening test for free fluid, retroperitoneal fluid, pleural effusion, and pericardial effusion, as well as soft tissue abnormalities via a target-organ approach. Veterinary Clin… The four named quadrants assessed are the diaphragmatic-hepatic (DH), hepatorenal, splenorenal, and cystocolic views. Journal of Vete… Add-on assessments at these same windows — without acquiring additional views — include caudal vena cava and hepatic vein evaluation for volume status, urinary bladder volume estimation for urine output tracking, screening for free air (pneumoperitoneum and pneumoretroperitoneum), and gastrointestinal motility assessment. Veterinary Clin…
AFAST incorporates an abdominal fluid scoring system that semiquantitates free fluid volume across the acoustic windows, enabling serial monitoring of fluid accumulation or resolution over time. Veterinary Clin… When free fluid is detected at the DH view, abdominocentesis can be performed and the fluid characterized — for example, turbid yellow-to-brown fluid cytologically consistent with bile Journal of the…, or clear yellow fluid with total solids below the reference interval of 2.5 g/dL and peritoneal lactate above the reference interval of 2.0 mmol/L. Journal of the…
TFAST uses 5 acoustic windows: bilaterally applied chest tube site views, bilaterally applied pericardial site views, and the diaphragmatic-hepatic view shared with AFAST. It is validated for rapid detection of pneumothorax, pleural effusion, and pericardial effusion in dogs and cats. Veterinary Clin… A defined set of TFAST rules governs image interpretation to prevent mistaking cardiac chambers for effusion. Veterinary Clin… TFAST echocardiography at these same windows screens for chamber size, contractility, volume status, and intracardiac abnormalities. Veterinary Clin…
Free fluid interpretation requires integrating cavity, character, and clinical context. Thoracic free fluid with swirling hyperechoic foci at 5–7 cm depth in the cranioventral pleural fields, confirmed by thoracocentesis yielding frank blood with pleural lactate comparable to peripheral blood lactate, supports hemothorax rather than intrathoracic ischemic viscera. Journal of the… Gallbladder wall edema (GBWE) detected on AFAST is a specific finding that warrants immediate integration of echocardiography, because pericardial effusion (PCE) is the most common cardiac cause of GBWE in dogs; ascites was present alongside GBWE in 69% of dogs with underlying cardiac disease in one case series. Journal of Vete… Detecting GBWE on AFAST without proceeding to TFAST and echocardiography risks the same misinterpretation error documented in human medicine, where cardiogenic GBWE led to unnecessary cholecystectomy. Journal of Vete…
Pericardial effusion identified on emergency FAST should prompt echocardiography, which is the most useful imaging modality for diagnosing cardiac tamponade and identifying sources including intracardiac or heart-base masses, infectious or inflammatory pericarditis, right heart failure, and left atrial rupture. Thoracic radiography has variable and often nondescript findings (globoid cardiac silhouette) in dogs with pericardial effusion and cannot identify the underlying cause. Journal of the…
Global FAST is performed cageside, requires no shaving, uses minimal restraint, is radiation-sparing, and provides real-time information on free fluid and soft tissue abnormalities of the abdomen, heart, and lung that are missed or only suspected by physical examination, blood and urine testing, and radiography alone. Veterinary Clin… Standardized recording of imaging data at all 15 points is integral to using Global FAST for serial patient monitoring and disease staging — distinguishing localized from disseminated disease and tracking treatment response over time. Veterinary Clin…
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