E fast scan for surgeons- skill lab procedure- osce - copy
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The document outlines the e-fast scan, a rapid, non-invasive ultrasound modality used for assessing fluid in peritoneal, pleural, and pericardial spaces in trauma patients. Key indications include trauma evaluation, patient triage, and unexplained hypotension, while contraindications mainly involve cases requiring immediate surgery. The e-fast scan covers areas such as the pericardial window, abdominal quadrants, and thoracic views, enhancing clinical decision-making despite limitations in sensitivity for certain injuries.
E fast scan for surgeons- skill lab procedure- osce - copy
- 1. e-FAST SCAN (Extended Focused Assessment with Sonography for Trauma) SKILL LAB OSCE Dr.B.SELVARAJ MS;Mch;FICS; “SURGICAL EDUCATOR” MALAYSIA
- 2. e-FAST SCAN FOR SURGEONS DEFINITION e-FAST- is used to assess peritoneal, pleural and pericardial spaces in trauma settings. The primary application is to find out the pathological free fluid in these spaces which is blood. INDICATIONS 1. Rapid evaluation of trauma caused by either blunt or penetrating injury. 2. To triage and prioritize patients for treatment. 3. Evaluating unexplained hypotension in either traumatic or nontraumatic settings.
- 3. e-FAST SCAN FOR SURGEONS CONTRAINDICATIONS 1. The only contraindication is the need for immediate laparotomy 2. Patients with penetrating trauma who are unstable should be taken directly to the operating theatre 3. Unstable patients with blunt trauma may undergo e-FAST to assess the need for surgery. 4. But if clinical suspicion regarding the need for exploratory laparotomy is high, the patient should be taken directly to the operating room.
- 4. e-FAST SCAN FOR SURGEONS EQUIPMENTS 1. e-FAST includes both echocardiographic and thoracoabdominal examination 2. Ideally performed with a single transducer that can image all areas with a 3.5- to 5-MHz curvilinear or convex array probe 3. Some physicians may choose to use a phased-array probe due to its better ability to capture movement.
- 5. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 1. Subxiphoid pericardial window 2. Right upper quadrant and hepatorenal pouch of Morrison 3. Left upper quadrant and peri-splenic area 4. Suprapubic region 5. Bilateral thoracic views for the evaluation of pneumothorax and hemothorax
- 6. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED For intra-pericardial hemorrhage
- 7. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 1. Subxiphoid pericardial window 1. The examination is done from the right side of the patient, who is placed supine 2. Direct the transducer under the xiphoid process, angled cephalad and toward the left shoulder in a horizontal plane. 3. Apply firm pressure to the body of the transducer to have it lie flat on the patient’s abdomen and allow the sound waves to pass under the xiphoid and into the pericardium. 4. Tilt the transducer to view all four cardiac chambers and the surrounding pericardium Epicardial fat pads move with the heart during contraction, whereas pericardial fluid tends to remain static. Ventricular wall motion and right ventricular filling should be evaluated.
- 8. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED For Intra-peritoneal hemorrhage
- 9. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 2.Right UPPER QUADRANT
- 10. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 2.Right UPPER QUADRANT Any fluid collection within the hepatorenal pouch would be noted by a black crescentic shape on ultrasound. Place patient in supine position Start between 11th and 12th ribs initially along the midaxillary line with the probe indicator directed cephalad. Fan the probe from anterior to posterior abdomen to evaluate liver, right kidney, and hepatorenal recess. The transducer is oriented as a coronal section (long axis) through the midaxillary line, extending from the 9th through 12th ribs. Normal exam will show bright line between kidney (K) and liver (L) with no anechoic spaces in between.
- 11. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 3.Left UPPER QUADRANT
- 12. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 3.Left UPPER QUADRANT 1. Left flank the most difficult examination to perform during E-FAST 2. Place the patient in the supine position 3. Transducer is directed toward the axilla and oriented in the coronal plane (long axis) through the body in the midaxillary to posterior axillary line extending from the ninth to twelfth ribs. 4. Transducer is angled cephalad in the long axis to allow anterior to posterior scanning by fanning the probe In Fig 1: a bright line is noted between the left kidney and spleen with no anechoic spaces in between. In Fig 2: fluid collection between these two structures seen as a black crescentic shape in ultrasound
- 13. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 4. SUPRA PUBIC AREA
- 14. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 4. SUPRA PUBIC AREA Place patient in supine position. The transducer is oriented in sagittal plane and placed just above the pubic symphysis and directed into the pelvis. Fan the transducer from left to right to image the bladder and observe for fluid collections Turn the transducer to the transverse position, move to the right, and place about 1-2 cm above the pubic symphysis with the probe angled caudally. Normal exam will show the bladder as a large black, fluid- filled structure; the surrounding areas external to the bladder show no anechoic materials. Surrounding areas external to the bladder show anechoic materials.
- 15. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 5. Bilateral Thoracic Views Place patient in supine position. The field depth is set to a lower level to allow proper visualization of the pleural space between the visceral and parietal pleurae and evaluation of the pleurae sliding on one another. Absence of pleural sliding implies the presence of pneumothoraces. Probe is placed between the second and fourth intercostal spaces at the midclavicular line or in the fourth through sixth intercostal spaces at the midaxillary line. Place the transducer in a longitudinal position, typically between the second through fourth intercostal spaces along the midclavicular line. Repeat on the other side to rule out pneumothoraces in either pleural space. To identify pneumothorax, a higher- frequency linear probe (5 to 12 MHz) is used for the thoracic examination.
- 16. e-FAST SCAN FOR SURGEONS AREAS TO BE EXAMINED 5. Bilateral Thoracic Views M-mode illustrating the ‘seashore sign.’/ sandy beach. The pleural line divides the image in half: The motionless portion above the pleural line creates horizontal ‘waves,’ and the sliding line below it creates granular pattern, the ‘sand’ M-mode and the absence of lung sliding are shown as the ‘stratosphere sign’: Parallel horizontal lines above and below the pleural line, resemble a ‘barcode.’ This sign indicates a pneumothorax at this intercostal space
- 17. e-FAST SCAN FOR SURGEONS TREATMENT ALGORITHM
- 18. e-FAST SCAN FOR SURGEONS TAKE HOME MESSAGE E-FAST is a non-invasive investigation that can be rapidly performed at the bedside of a patient with trauma who is hypotensive. Because it is non-invasive and does not involve ionizing radiation, E-FAST may be serially repeated as needed, aiding the clinician in management decisions. The original FAST focused on assessing the pericardium, the right and left flanks, and the pelvic region. E-FAST expands on FAST by more thoroughly investigating the pleural cavities with a high-frequency linear transducer to look for pneumothorax While not sensitive for intraperitoneal haemorrhage or solid organ injury, the effectiveness of E-FAST aids in the clinical decision-making process The sensitivity of E-FAST may be increased with improved operator training and serial examinations to monitor the patient for changes.