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S
EFAST
A Charlies how to guide.
Dr Kyle Kophamel
CME Talk
19th February 2015
Objectives
S Overview of the the EFAST Scan
S Use in Trauma
S Advantages and limitations
S Demonstrate Technique
S Normal ...
EFAST
Definition
S Extended
S Focused
S Assessment with
S Sonography in
S Trauma
EFAST
How can we use it?
S Clinical Examination
S Answers specific Questions
S Is there free fluid in the abdomen?
S Is th...
EFAST
How’s it performed?
S Real time Views
S Abdominal
S Perihepatic/RUQ
S Perisplenic/LUQ
S Pelvic (Long and Trans)
S Ca...
EFAST
Views
S Perihepatic/RUQ
S Probe in longitudinal orientation
S Lower ribs of right chest wall
S Mid-axillary line sli...
EFAST
Views
S Perisplenic/LUQ
S Longitudinal Probe orientation
S Mid to post axillary line
S Often more posterior view wit...
EFAST
Views
S Pelvic
S Just above symphysis pubis
S Transverse and Longitudinal probe orientation
S Female vs Male
S Pitfa...
EFAST
Views
S Pericardial View
S Left Subcostal probe position
S Angled under ribcage, towards left shoulder
S Pitfalls
S ...
EFAST
Views
S Lung
S Most anterior chest spaces in supine patient
S Parasternal, longitudinal
S Bat shape
S Lung sliding (...
EFAST
What does is mean?
S Free fluid is anechoic/sonolucent (Black) and has
angularity to it’s margins (ie. takes the sha...
EFAST
How does it help?
S Guides Management
S Prioritization
S What should be dealt with first
S Ensures more accurate ass...
EFAST
How does it not help?
S Wrong questions
S Is there any intraperitoneal bleeding?
S Is there any intra-abdominal inju...
EFAST
Pros
S Rapid and Bedside
S Non-Invasive
S Repeatable
S High sensitivity and specificity
S Depends on the question be...
EFAST
Cons
S Low Sensitivity and Specificity
S if the wrong question asked
S Operator dependent
EFAST
Pathology
EFAST
Training/Education
S http://scghed.com/ed-orientation/ultrasound-where-do-i-start/
S Basic Ultrasound Course
S US Ph...
EFAST
Training/Education
S Logbook
S 25-50 supervised scans per module
S Accreditation
S CCPU (ASUM)
References
S www.ultrasoundvillage.com
S thesonocave.com
S www.asum.com.au/newsite/Education.php?p=CCPU
S www.lifeinthefas...
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
EFAST - A how to guide
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EFAST - A how to guide

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EFAST - A how to guide

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EFAST - A how to guide

  1. 1. S EFAST A Charlies how to guide. Dr Kyle Kophamel CME Talk 19th February 2015
  2. 2. Objectives S Overview of the the EFAST Scan S Use in Trauma S Advantages and limitations S Demonstrate Technique S Normal and abnormal scans S Training and Accreditation
  3. 3. EFAST Definition S Extended S Focused S Assessment with S Sonography in S Trauma
  4. 4. EFAST How can we use it? S Clinical Examination S Answers specific Questions S Is there free fluid in the abdomen? S Is there free fluid in the pericardium? S Is there evidence of a pneumothorax/haemothorax? S Guides management
  5. 5. EFAST How’s it performed? S Real time Views S Abdominal S Perihepatic/RUQ S Perisplenic/LUQ S Pelvic (Long and Trans) S Cardiac S Pericardial (usually subcostal) S Thorax S RUQ S LUQ S Parasternal
  6. 6. EFAST Views S Perihepatic/RUQ S Probe in longitudinal orientation S Lower ribs of right chest wall S Mid-axillary line slide posteriorly S Morrisons Pouch S Subdiaphragmatic space S Right costo-phrenic angle
  7. 7. EFAST Views S Perisplenic/LUQ S Longitudinal Probe orientation S Mid to post axillary line S Often more posterior view with deep inspiration S Leino-renal space S Perisplenic S Left costo-phrenic angle
  8. 8. EFAST Views S Pelvic S Just above symphysis pubis S Transverse and Longitudinal probe orientation S Female vs Male S Pitfalls S Bowel fluid S Empty Bladder
  9. 9. EFAST Views S Pericardial View S Left Subcostal probe position S Angled under ribcage, towards left shoulder S Pitfalls S Pleural effusions S Pericardial fat pad
  10. 10. EFAST Views S Lung S Most anterior chest spaces in supine patient S Parasternal, longitudinal S Bat shape S Lung sliding (“trail of ants”) S Lung comets (Presence excludes PTx) S PTx S Loss of lung sliding S Lung point sign
  11. 11. EFAST What does is mean? S Free fluid is anechoic/sonolucent (Black) and has angularity to it’s margins (ie. takes the shape of it’s container) S Clot appears echogenic S Cannot differentiate fluid types S Clinical context is important (+/- diagnostic aspiration) S Generally require greater than 100-250mls free fluid S Dependent on bladder fullness/patient size/sonographer skill
  12. 12. EFAST How does it help? S Guides Management S Prioritization S What should be dealt with first S Ensures more accurate assessment S Thoroughness
  13. 13. EFAST How does it not help? S Wrong questions S Is there any intraperitoneal bleeding? S Is there any intra-abdominal injury? S Can I send the patient home?
  14. 14. EFAST Pros S Rapid and Bedside S Non-Invasive S Repeatable S High sensitivity and specificity S Depends on the question being asked/answered S Consider it as part of Primary survey S Chest = CXR S Abdomen = FAST
  15. 15. EFAST Cons S Low Sensitivity and Specificity S if the wrong question asked S Operator dependent
  16. 16. EFAST Pathology
  17. 17. EFAST Training/Education S http://scghed.com/ed-orientation/ultrasound-where-do-i-start/ S Basic Ultrasound Course S US Physics/Essentials S AAA S EFAST S Vascular Access S BELS S DVT
  18. 18. EFAST Training/Education S Logbook S 25-50 supervised scans per module S Accreditation S CCPU (ASUM)
  19. 19. References S www.ultrasoundvillage.com S thesonocave.com S www.asum.com.au/newsite/Education.php?p=CCPU S www.lifeinthefastlane.com/ccc/pneumothorax-ultrasound/ S www.lifeinthefastlane.com/trauma-tribulation-019/ S Fildes J, et al. Advanced Trauma Life Support Student Course Manual (8th edition), American College of Surgeons 2008 S Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014 Jan 9;4(1):1. doi: 10.1186/2110-5820-4-1 S Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995 Nov;108(5):1345-8

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