Ultrasound in Emergency Medicine| Volume 47, ISSUE 4, P427-429, October 2014

Download started.


Positive FAST Without Hemoperitoneum Due to Fluid Resuscitation in Blunt Trauma



      The focused assessment with sonography in trauma (FAST) examination is an important screening tool in the evaluation of blunt trauma patients.


      To describe a case of a hemodynamically unstable polytrauma patient with positive FAST due to fluid resuscitation after blunt trauma.

      Case Report

      We describe a case of a hemodynamically unstable polytrauma patient who underwent massive volume resuscitation prior to transfer from a community hospital to a trauma center. On arrival at the receiving institution, the FAST examination was positive for free intraperitoneal fluid, but no hemoperitoneum or significant intra-abdominal injuries were found during laparotomy. In this case, it is postulated that transudative intraperitoneal fluid secondary to massive volume resuscitation resulted in a positive FAST examination.


      This case highlights potential issues specific to resuscitated trauma patients with prolonged transport times. Further study is likely needed to assess what changes, if any, should be made in algorithms to address the effect of prior resuscitative efforts on the test characteristics of the FAST examination.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stengel D.
        • Bauwens K.
        • Sehouli J.
        • et al.
        Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma.
        Cochrane Database Syst Rev. 2005; 2: CD004446
        • Rozycki G.S.
        • Ballard R.B.
        • Feliciano D.V.
        • Schmidt J.A.
        • Pennington S.D.
        Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients.
        Ann Surg. 1998; 228: 557-567
        • Scalea T.M.
        • Rodriguez A.
        • Chiu W.C.
        • et al.
        Focused sssessment with sonography for trauma (FAST): results from an international consensus conference.
        J Trauma. 1999; 46: 466-472
        • Rose J.S.
        Ultrasound in abdominal trauma.
        Emerg Med Clin North Am. 2004; 22: 581-599
        • Melniker L.A.
        • Leibner E.
        • McKenney M.G.
        • Lopez P.
        • Briggs W.M.
        • Mancuso C.A.
        Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial.
        Ann Emerg Med. 2006; 48: 227-235
        • Diercks D.B.
        • Mehrotra A.
        • Nazarian D.J.
        • Promes S.B.
        • Decker W.W.
        • Fesmire F.M.
        Clinical policy: critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma.
        Ann Emerg Med. 2011; 57: 387-404
        • Nishijima D.K.
        • Simel D.L.
        • Wisner D.H.
        • Holmes J.F.
        Does this adult patient have a blunt intra-abdominal injury?.
        JAMA. 2012; 307: 1517-1527
        • Hoff W.S.
        • Holevar M.
        • Nagy K.K.
        • et al.
        Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group.
        J Trauma. 2002; 53: 602-615
        • American College of Surgeons Committee on Trauma
        Advanced trauma life support student course manual.
        8th edn. American College of Surgeons, Chicago2008
        • Isenhour J.L.
        • Marx J.A.
        Abdominal trauma.
        in: Marx J. Hockberger R. Walls R. Rosen's emergency medicine: concepts and clinical practice, volume 1. 7th edn. Mosby Elsevier, Philadelphia2010: 414-434
        • Blackbourne L.H.
        • Soffer D.
        • McKenney M.
        • et al.
        Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma.
        J Trauma. 2004; 57: 934-938
        • Nathens A.B.
        • Jurkovich G.J.
        • Maier R.V.
        • et al.
        Relationship between trauma center volume and outcomes.
        JAMA. 2001; 285: 1164-1171
        • Harrington D.T.
        • Connolly M.
        • Biffl W.L.
        • Majercik S.D.
        • Cioffi W.G.
        Transfer times to definitive care facilities are too long: a consequence of an immature trauma system.
        Ann Surg. 2005; 241: 961-968