I am often asked how come we don't religiously do FAST exams in pediatric trauma. So this week let's discuss the utilization of the FAST exam.

This is such an important issue because, in abdominal trauma, these patients are at higher risk for injuries. This is the case for a few reasons.

They are smaller in size allowing for a single impact to injure multiple organs
Their abdominal wall is thin providing less protection from these injuries.

ABCs, primary survey should always be done first.

Tachycardia in a peds trauma should never be ignored because you think it's due to the kid crying and scared. You will absolutely miss the SUBTLE sign of hemodynamic instability.
In TRAUMA, assume tachycardic is due to volume loss and start with fluid resuscitation.

The FAST exam can and SHOULD be utilized in pediatric abdominal trauma, but it has some limitations. Consider using the phased array probe ,which has a smaller footprint, to allow for easier windows.

A Positive FAST = definitive imaging by CT scan if stable.

A negative FAST is not so clear. . Not all children with abdominal injuries will have free fluid on the FAST exam. This can lead to being falsely reassured by a negative FAST exam.

Use this algorithm from PECARN for abdominal injury for utilization of CT

**CT A/P everyone with abdominal wall trauma, seatbelt sign, GCS < 14**

NO EXCEPTIONS!

signs of abdominal wall trauma for reference

Be wary of pancreatic injuries. If the patient still complains of abdominal pain after a negative CT, pt should likely be admitted for observation. Maybe an amylase, lipase would be helpful in this case. 😉

Management

Pediatric management of abdominal solid organ injuries is mainly conservation management. Patient are admitted to an ICU setting for serial hemoglobin monitoring and abdominal exams.

So then why should we do it??

-----> The " EX-FAST " the fast enhanced physical exam