Fast Protocol and Machine Workflow

Authors: Gabriel Ruiz – 4/11/23
Approval: Nicholas Namias – 4/11/23

General Considerations:

Keep the machine connected to the power source at all times. Fold the screen for transport.
Do not place patient labels on the machine, the adhesive will damage the glass.
Always place a protective sleeve on the probe BEFORE Starting Exam
When in doubt, discuss the indication to perform the exam with the attending or the senior surgery resident / trauma Fellow
Do not start the FAST until the patient’s primary survey has been done and any issues with airway, breathing, hemodynamic instability or impending brain herniation have been addressed
After finalizing the exam, remove and discard the protective sleeve from the probe. Clean the probe and the machine after every exam with Red-Top wipes only. Do not start an exam with a visibly soiled probe, a reused sleeve, or soiled machine.
The machines are cleaned several times during the day by the ancillary staff.

Do not start an exam without a protective sleeve on the probe

Turn the machine on by pressing the ON button located on the left corner of the machine. The booting time is approximately 20 seconds
The machine will immediately go into the Patient information screen
Scan the large QR code on the patient’s identification bracelet and confirm that the patient’s demographics have transferred into the machine screen.

Be sure to get the identification of the patient BEFORE you start the exam – unidentified FAST exams cannot be uploaded to the PACS system

The machine will go into the scanning mode. The default Exam type is “Abdomen” and the probe is the “P19” at 5-1MHz.
Freeze the still images for the RUQ, LUQ, Pelvis and Lung views. Obtain video clips of the pericardium and of every positive/indeterminate view.
Use “M MODE” for the lung views
See the Ryder FAST protocol document (Appendix) for the quality requirements on every image. The images can be reviewed for good technique, anatomical requirements and interpretation by any member of the faculty.
Once all the images are obtained you can either review the exam by pressing the “REVIEW” tab on the top or end the exam by pressing the “END EXAM” button
Once the exam is ended, the machine will automatically upload the images into the PACS system. The images are paired to the patient record by using the identification information.
Clean the probe and the machine to remove the ultrasound gel and any body fluid thoroughly with the Red-Top wipes only. You will find it in the bucket on the back of the machine. Alert Ancillary services if there are no wipes or ultrasound gel available.

Do not end the Exam before scanning the patient’s demographics from the identification bracelet QR code

Documentation of the FAST exam in the CARE system is mandatory
Every FAST exam should be properly documented for technique and interpretation, and the note should be sent to the attending supervising the exam
Once, finished, the CARE note will be automatically transferred into Cerner
Reporting the findings and interpretation of the FAST exam on the Cerner note does not preclude properly documenting the exam on the CARE system.
If the FAST is repeated due to patient clinical deterioration, it has to be documented again

Turn the machine on by pressing the ON button located on the left corner of the machine. The booting time is approximately 20 seconds
The machine will immediately go into the Patient information screen
Scan the large QR code on the patient’s identification bracelet and confirm that the patient’s demographics have transferred into the machine screen.

Be sure to get the identification of the patient BEFORE you start the exam – unidentified FAST exams cannot be uploaded to the PACS system

The machine will go into the scanning mode. The default Exam type is “Abdomen” and the probe is the “P19” at 5-1MHz.
Freeze the still images for the RUQ, LUQ, Pelvis and Lung views. Obtain video clips of the pericardium and of every positive/indeterminate view.
Use “M MODE” for the lung views
See the Ryder FAST protocol document (Appendix) for the quality requirements on every image. The images can be reviewed for good technique, anatomical requirements and interpretation by any member of the faculty.
Once all the images are obtained you can either review the exam by pressing the “REVIEW” tab on the top or end the exam by pressing the “END EXAM” button
Once the exam is ended, the machine will automatically upload the images into the PACS system. The images are paired to the patient record by using the identification information.
Clean the probe and the machine to remove the ultrasound gel and any body fluid thoroughly with the Red-Top wipes only. You will find it in the bucket on the back of the machine. Alert Ancillary services if there are no wipes or ultrasound gel available.

Do not end the Exam before scanning the patient’s demographics from the identification bracelet QR code

Documentation of the FAST exam in the CARE system is mandatory
Every FAST exam should be properly documented for technique and interpretation, and the note should be sent to the attending supervising the exam
Once, finished, the CARE note will be automatically transferred into Cerner
Reporting the findings and interpretation of the FAST exam on the Cerner note does not preclude properly documenting the exam on the CARE system.
If the FAST is repeated due to patient clinical deterioration, it has to be documented again