The diagnostic method of choice for evaluating patients with suspected blunt abdominal trauma is the abdominal FAST (AFAST) exam, with ultrasound-guided or 4-quadrant needle abdominocentesis if free abdominal fluid is noted. Consider CT if advanced imaging is available.
Perform an AFAST exam during the initial evaluation phase of every MWD with a history of trauma, acute collapse, or weakness. FAST is proven in dogs to be extremely reliable in detecting free abdominal fluid and can be performed rapidly during resuscitation.8
Figure 39. Imaging Locations for AFAST.
Figure 39 shows ultrasound probe placement sites for AFAST scanning of dogs. The dog‘s head is to the left; the dog is in right lateral recumbency.
DH = diaphragmatic-hepatic
SR = splenorenal
CC = cystocolic
HR = hepatorenal
Perform a 4-quadrant abdominocentesis in any patient with free fluid in the abdomen.9 This technique is quick and easy to perform, and usually differentiates abdominal hemorrhage or biliary or urinary tract injury. The general rule of thumb is that a positive peritoneal tap is a reliable indicator that some hemorrhage has occurred or that free urine or bile is in the abdominal cavity, but that a negative tap does not rule these out.
Consider DPL in any MWD in which major abdominal trauma is suspected, but AFAST and abdominocentesis are unrewarding.9 If available, CT or MRI may be better modalities.