Objectives: To evaluate the introduction of a focussed assessment with sonography in trauma (FAST) scan into the early assessment of trauma patients in the UK. Methods: The setting was an inner city teaching hospital emergency department (annual attendance 100 000). All patients aged 16 or over admitted to the resuscitation room after blunt trauma were included in a prospective observational study. Patients had a FAST scan performed at the end of the primary survey. Results were compared to results of other investigations, laparotomy, postmortem examination, or observation. Results: 153 patients were entered into the study. The sensitivity of the FAST scan was 78% and specificity was 99%. Conclusion: FAST is a highly specific ''rule in'' technique and is useful in the initial assessment of trauma patients. Emergency physicians can perform FAST after a brief training period.

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Ultrasound is widely used in the US and continental Europe in the immediate assessment of patients after blunt abdominal trauma. There are also now other recognised "primary" indications for ultrasound in emergency medicine.In this paper current evidence supporting the implementation and use of emergency ultrasound in these primary conditions and possible other indications are assessed. The issues surrounding introduction of the technology into the practice of emergency medicine in this country are considered. It is accepted that further debate is necessary but the establishment of a robust evidence base in the UK will help to clarify the place of ultrasound.

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A case is reported of the Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation had been abandoned) in a patient following recreational drug use. The implications for management of cardiac arrest in the emergency department are discussed. (Emerg Med J 2001;18:74-75)