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E-FAST
Stephanie Doniger, MDEmergency Ultrasound Fellow
St. Luke’s-Roosevelt Hospital CenterFebruary, 2008
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FAST
•Blunt trauma
•Penetrating trauma
•Yes/No questions
•Is there free fluid/blood in the abdomen?
•Is there fluid/blood in the pericardium?
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E-FAST
•E = extended FAST
•Lung
•Yes/No questions
•Is there fluid/blood in the thorax?
•Is there a PTX?
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E-FAST Technique
•Trendelenburg position
•5-10 degrees
•Low frequency probe
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E-FAST Views
•Morison’s Pouch
•Splenorenal
•Pelvic
•Pericardial/subcostal
•Thorax
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Morison’s Pouch•Most SN
•RUQ
•Ant axillary line
•7th-9th IC space
•Oblique
•Look above diaphragms
Courtesy of http://sinaiem.us
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Morison’s: Normal
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Morison’s: Abnormal
QuickTime™ and aMicrosoft Video 1 decompressorare needed to see this picture.
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Above the Diaphragm
Diaphragm
Liver
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Splenorenal
Courtesy of http://sinaiem.us
•LUQ
•Posterior & superior
•Posterior ax line @ 5th-9th IC space
•Oblique rotation (10-20 deg)
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Splenorenal: Normal
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Splenorenal: Abnormal
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Bladder
•Most dependent area of peritoneal cavity
•Best prior to Foley placement
•w/Foley: instillation of saline
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Bladder
Courtesy of http://sinaiem.us
•Suprapubic
•TV & Longit views
•Often too superior
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Bladder: Normal
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Bladder TV: Normal
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Bladder: Abnormal
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Bladder: Abnormal
QuickTime™ and aMicrosoft Video 1 decompressorare needed to see this picture.
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Bladder: Abnormal
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Cardiac
•Detection of pericardial fluid
•Subxiphoid preferred
•Alternative: parasternal or apical
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Cardiac SX
Courtesy of http://sinaiem.us
•Subcostal
•Probe almost flat
•Use L lobe of liver
•Bent knees
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Cardiac: Normal SX
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Cardiac: Abnormal SX
QuickTime™ and a decompressor
are needed to see this picture.
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Cardiac: Abnormal PSL
QuickTime™ and aMicrosoft Video 1 decompressorare needed to see this picture.
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Lung
•Detection of pleural fluid
•Detection of pneumothorax
•(1) Abdomen: superior to diaphragm
•(2) Lung: pleural interface
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Lung
Courtesy of http://sinaiem.us
•3-5 MHz or 5-10 MHz
•Mid-clavicular line
•3rd-5th IC space
•Longitudinal
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Lung: Technique
•“Bat-sign”
•Ribs & pleural line
•Landmark to see pleural interface
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Lung: Normal
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Lung: Normal
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Lung•Comet tails
•US bouncing btwn 2 closely spaced interfaces
•Sliding
•Back & forth mov’t pleura w/respiration
•Abnormal: absence of comet tails & sliding
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Lung: Comet Tails
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Lung: Sliding•Real-time
•M-Mode
•“Seashore” sign = normal
•Smooth lines above pleura; rough below
•“Stratosphere” or “bar-code” sign = abnormal
•Lines uniformly straight/smooth
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Lung: Real-Time
QuickTime™ and aGIF decompressor
are needed to see this picture.
QuickTime™ and aGIF decompressor
are needed to see this picture.
Normal PTX
Courtesy of http://sinaiem.us
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Lung: M-Mode
Seashore Stratosphere
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Pitfalls•Not having patient in Trendelenberg
•Improper probe positioning
•Not scanning through or viewing in multiple planes
•Not repeating E-FAST scans
•Failure to act on & document (+) scans
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Questions
?