Provides an extension of the normal clinical examination in a trauma setting Asks a specific question and gives a specific answer The answers to these questions can then be interpreted to guide management
Bowel fluid is round – but free/dependant fluid has sharp demarcartion
Look for fluid between the pericardium and the heart
High specificity High sensitivity – user dependant Better sensitivity than supine CXR Not as good as CT
Blood/Urine/Ascites look the same – especially to the untrained eye! Clinical context is important
Examine and reexamine to ensure that nothing is missed. Advantage of serial EFAST
EFAST - A how to guide
A Charlies how to guide.
Dr Kyle Kophamel
19th February 2015
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
S Assessment with
S Sonography in
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
How’s it performed?
S Real time Views
S Pelvic (Long and Trans)
S Pericardial (usually subcostal)
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
S Longitudinal Probe orientation
S Mid to post axillary line
S Often more posterior view with deep inspiration
S Leino-renal space
S Left costo-phrenic angle
S Just above symphysis pubis
S Transverse and Longitudinal probe orientation
S Female vs Male
S Bowel fluid
S Empty Bladder
S Pericardial View
S Left Subcostal probe position
S Angled under ribcage, towards left shoulder
S Pleural effusions
S Pericardial fat pad
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 Loss of lung sliding
S Lung point sign
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
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
How does it help?
S Guides Management
S What should be dealt with first
S Ensures more accurate assessment
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?
S Rapid and Bedside
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
S Low Sensitivity and Specificity
S if the wrong question asked
S Operator dependent
S Basic Ultrasound Course
S US Physics/Essentials
S Vascular Access
S 25-50 supervised scans per module
S CCPU (ASUM)
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