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In respiratory‐compromised patients AFAST is performed in standing or sternal knowing that the fluid scoring system is not validated in this positioning but still provides clinical information regarding the presence or absence of effusion. Whatever the AFAST options for positioning (lateral, modified lateral‐sternal, standing/sternal), a negative AFS negates the need for moving the patient to lateral recumbency. Serial exams are always mandated as standard of care for a second opportunity to detect negative AFAST changing to positive, and for rescoring the patient (Lisciandro et al. 2009; Lisciandro 2011, 2014a; Boysen and Lisciandro 2013). See Chapters 36 and 37 for the most efficient ways to perform AFAST in standing‐sternal positioning.

Figure 6.3. AFAST and its five views performed in left lateral recumbency in a dog. Shown is AFAST unlabeled in left lateral recumbency with the same images as Figure 6.2A and B. The order is analogous and always the same as follows: DH to HR to CC to SRU to SR5th bonus view. The final SR5th bonus view is not part of the abdominal fluid score. DH, diaphragmatico‐hepatic view; DH1, DH 1 of 2 views; DH2, DH 2 of 2 views; SR, spleno‐renal view; CC, cysto‐colic view; HRU, hepato‐renal umbilical view; HR5th, hepato‐renal 5th bonus view; HRU1, 1 of 2 views; HRU2, 2 of 2 views. DIA, diaphragm; FF, free fluid; GB, gallbladder; LIV, liver; LK, left kidney; RK, right kidney; SI, small intestine. Note that the images should look identical for each AFAST view regardless of positioning (including standing/sternal, modified sternal). AFAST views are nearly identical no matter the positioning because the respective target organs are imaged with the same methodology.

Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX. Illustration by Hannah M. Cole, Adkins, TX.