We will cover common artifacts during Global FAST® which includes AFAST®, abdomen, TFAST®, which includes thorax – pleural space and heart, and Vet BLUE®, which includes lung, and their features that should be known and recognized by the sonographer to prevent misinterpretation of point-of-care ultrasound findings. These artifacts are broken down into air-related, fluid-related, curved-surface related, and reflectors as the author’s categories. By knowing how some of these artifacts are created and where they are most common, the probability of an accurate interpretation of ultrasound imaging findings is increased.

We will cover image acquisition for the 5-acoustic windows (views) of the AFAST exam and its “target-organ approach” to not only detect free fluid but also for obvious soft tissue abnormalities with clear advantages over physical exam, basic blood and urine testing, and radiography. Through the AFAST Approach and its 5 standardized views, the clinician “sees their problem list” and thus diagnostic and treatment plans are often more accurate and better streamlined. Applications are widespread and practical for all veterinarians including the general practitioner, the emergency veterinarian, and the clinical specialist.

We will cover AFAST and its abdominal fluid scoring system, its more recent “weak positive-strong positive modification” with its “small volume-large volume principles” for decision-making regarding fluid resuscitation, including blood transfusions versus crystalloids, and medical versus surgical clinical course. Patient subsets include trauma, blunt and penetrating, non-trauma, the collapsed patient, and post-interventional (The author’s published “T3” of AFAST -Trauma, Triage, Tracking). Our veterinary AFAST fluid scoring system that semi-quantitates ascitic volume has clear advantages for our patients over human medicine in which fluid scoring systems are not routinely used.

We will cover TFAST and its 5-view design for detecting pneumothorax; and pleural and pericardial effusion by using our set of TFAST rules. These rules are important to help avoid mistaking heart chambers for either type of effusion or heart anatomy for other abnormalities. Common causes for pericardial effusion in both dogs and cats will be covered. Overcoming “confirmation bias error” and “satisfaction of search error”, clinical imaging pearls, and advantages and limitations of TFAST as compared to radiography will also be discussed.

We will cover fundamental TFAST echocardiography views for obvious abnormalities of the left- and right-heart, general systolic dysfunction, volume status, and soft tissue abnormalities missed or only suspected by thoracic radiography. The EPIC Guidelines and their mandated echocardiography measurements will be detailed. Fundamental TFAST echocardiography has clear advantages over the radiographic cardiac silhouette; and can detect cardiac-related pathology including masses and intracardiac heartworms.

We will discuss the evolution of lung ultrasound beginning over 30-years ago in 1986 and some important findings that led to its clinical use in people and animals. Following the short introduction, we will review how to perform Vet BLUE and its 9 unique regional views, the lung ultrasound artifacts of “wet lung” versus “dry lung”, the novel Vet BLUE B-line scoring and its inherent severity scoring system for assessing and tracking respiratory patients, and its signs of consolidation – Shred, Tissue, Nodule, and Wedge Signs. Vet BLUE is advantageous as a unique and novel regional, pattern-based approach for developing a working diagnosis for common small animal respiratory conditions. Comparisons to radiography and computed tomography will be made discussing advantages and limitations of the Vet BLUE approach.

We will discuss beyond Vet BLUE image acquisition and “wet lung” versus “dry lung” artifacts of the first talk to introduce the Vet BLUE lung ultrasound signs of consolidation, e.g. Shred Sign, Tissue Sign, Nodule Sign, and Wedge Sign, referred to as the Vet BLUE Visual Lung Language. Our system has clear advantages over the esoteric “line system” and other veterinary lung ultrasound formats that are sliding and quadrant based.