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Diagnostic ultrasound (U/S) has been used in medicine for over 40 years, and reports describing the use of abdominal U/S in trauma date back to 1971. Recently, however, trauma ultrasonography has become a controversial issue in Canada. U/S provides the speed and accuracy we associate with diagnostic peritoneal lavage (DPL) in a noninvasive format. It is safe, inexpensive, repeatable, accessible at the bedside, and requires little patient preparation. U/S is now the initial test for the assessment of blunt abdominal trauma in most European and Australasian centres. More recently U/S has become common in US trauma centres. A focused abdominal sonogram in trauma (FAST) exam takes 5 minutes or less. The FAST scan examines the right upper quadrant, left upper quadrant, subxiphoid area, pelvis at the pouch of Douglas, and, in some cases, the paracolic gutters. But can FAST scans tell us which patients require surgery? English-language publications document trauma U/S data from over 10,000 patients. These data suggest that U/S is 80–100% sensitive and 88–100% specific for detecting hemoperitoneum in adult, pediatric, blunt or penetrating abdominal trauma. Serial scanning over minutes to hours increases both sensitivity and specificity. Several studies have compared U/S, either single or serial, with DPL and CT. The figures presented in Table 1 are typical of the results of these studies. Although sensitive for hemoperitoneum, U/S, like CT, has poor sensitivity (in the range of 50–60%) for hollow viscus and pancreatic injuries. Most studies report U/S

Ultrasound in the emergency department: Emergency department ultrasound for the assessment of abdominal trauma: an overview