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68 years old gentleman presented to the ED with 2 days history of off and on right leg discoloration. Today he developed some pain, which had become worse over the last few hours. On arrival to the ED he had severe pain with obviously pale leg. The patient had no past medical history. On examination he had normal observations. The right leg was obviously discolored (pale) and absent pulses from popliteal level and below.  The bedside ultrasound was performed which showed:

Focused Assessment Scanning in Trauma is well know for its use in dealing with Major Trauma patients. There is good amount of evidence to prove its effectiveness in terms of sensitivity and specifiicty. One of the systemetic review showed a negative predictive values ranged from 0·72 to 0·99 with the use of FAST. Overall, FAST has a sensitivity of 73%-88%, a specificity of 98%- 100% and is 96%-98% accurate. There is always a question about its use if we are going to do the WBCT. In unwell hypotensive patients it might guide you (FAST +ve) to take the patient to theatre and if we know someone has positive FAST then we can get the theatre and surgical teams ready while patient goes for CT for more definitive diagnosis. Otherwise till we have the CT done we might not know if patient has blodd in chest, arounf heart and abdomen.  FAST works as an adjunct which seepds up the overall management of the patient. Therefore should be encouraged to perform but not at the cost of delaying CT or time to theatre.

History: