EFAST - A how to guide
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This document provides an overview of the EFAST (Extended Focused Assessment with Sonography in Trauma) scan. It describes the objectives, definition, views, and techniques used in an EFAST exam to rapidly assess trauma patients for free fluid in the abdomen, chest, or pericardium. The advantages of EFAST are discussed, such as its speed, non-invasiveness, and ability to guide trauma management. Limitations include operator dependence and inability to differentiate fluid types. Training requirements are also outlined.
EFAST - A how to guide
- 1. S EFAST A Charlies how to guide. Dr Kyle Kophamel CME Talk 19th February 2015
- 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. EFAST Definition S Extended S Focused S Assessment with S Sonography in S Trauma
- 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. 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. 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
- 9. 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
- 12. 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
- 17. 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
- 20. 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
- 21. 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
- 22. EFAST How does it help? S Guides Management S Prioritization S What should be dealt with first S Ensures more accurate assessment S Thoroughness
- 23. 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?
- 24. 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
- 25. EFAST Cons S Low Sensitivity and Specificity S if the wrong question asked S Operator dependent
- 26. EFAST Pathology
- 32. 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
- 33. EFAST Training/Education S Logbook S 25-50 supervised scans per module S Accreditation S CCPU (ASUM)
- 35. 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
Editor's Notes
- #5: 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
- #13: Bowel fluid is round – but free/dependant fluid has sharp demarcartion
- #18: Look for fluid between the pericardium and the heart
- #21: High specificity High sensitivity – user dependant Better sensitivity than supine CXR Not as good as CT
- #22: Blood/Urine/Ascites look the same – especially to the untrained eye! Clinical context is important
- #23: Examine and reexamine to ensure that nothing is missed. Advantage of serial EFAST