E-FAST

Definition of POSITIVE E-FAST EXAM
- Free intra-peritoneal fluid
- and/or pericardial fluid
- and/or pneumothorax / hemothorax

STEPS

1. Right upper quadrant
  • Starting point - draw an imaginary line from the xiphisternum to the right mid-axillary line.
  • Ultrasound probe held in a horizontal, coronal plane, pointer towards patient's head.
  • Look for free fluid around the hepato-renal space (Morrison's pouch). Fluid appears black (anechoic) on ultrasound - blood or ascites will look the same!
  • Scan around the liver looking at the liver edge, the sub-diaphragmatic space, and the inferior renal pole (these are common areas where small amounts of fluid accumulates).
Positive RUQ Fast exam





2. Left upper quadrant
  • Starting point - draw an imaginary line from the xiphisternum to the left posterior-axillary line.
  • Ultrasound probe held in a horizontal, coronal plane, pointer towards patient's head.
  • Look for free fluid around the splenorenal space.
  • Scan around the spleen, the sub-diaphragmatic space, and the superior and inferior renal poles (these are common areas where small amounts of fluid accumulates).
Positive LUQ Fast exam





3. Bladder view
  • Scan in BOTH transverse AND longitudinal / sagittal orientations, ultrasound probe between the umbilicus and the symphysis pubis.
  • Sweep through the bladder in both planes.
  • May need to angle probe inferior if bladder is empty or catheterized (i.e. peer under the symphysis pubis).
  • Most often fluid is seen superior to the bladder. Larger volumes of intra-peritoneal fluid will fill the recto-vesical pouch (males) or the recto-uterine pouch (Pouch of Douglaus in females).
Positive pelvic FAST exam





4. Subxiphoid view
  • Use the cardiac probe (small foot-print phase array), select appropriate depth
  • Probe held at a shallow angle below the xiphisternum, or slide slightly towards patient's right hypochondrium
  • Point probe at patient's head superiorly, using an overhand grip. Angle slightly towards patient's left shoulder to improve image.
  • Use the left lobe of the liver as an acoustic window
  • Visualize the 4 chambers of the heart.
  • Pericardial fluid appears as a black rim surrounding the heart. Look between the liver and the immediate adjacent cardiac chambers (right ventricle and right atrium).
Subxiphoid view with pericardial effusion





5. Right and Left anterior chest
  • Use the linear probe
  • Longitudinal / sagittal plane, at the right and left anterior chest, mid-clavicular line, around the 3rd and 4th intercostal space.
  • The pleural line is identified as a hyperechoic line just beneath the ribs. Lung sliding occurs during respiratory effort, when the parietal and visceral pleura slide against each other and can be appreciated on ultrasound.
  • Presence of lung sliding excludes pneumothoraces.
  • Absence of lung sliding may be due to pneumothoraces, or other conditions preventing / reducing air movement in that lung (mucous plug, tumor, foreign body, ARDS, pneumonia, apnea)
  • A lung point is a very specific finding for pneumothorax but is not sensitive.
Normal lung sliding





Absent lung sliding





Lung point







Comprehensive video tutorial on performing the FAST exam





Comprehensive video tutorial on performing lung ultrasound to detect pneumothorax







References
1. Stengel D, et al. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004446

2. Melniker LA, et al. Randomized controlled clinical trial of point-of-care, limited ultrasonography  in the emergency department: the First Sonography Outcomes Assessment Program Trial. Academic Emergency Medicine 2006; 48:227-35.

3. Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: The extended focused assessment with sonography for trauma (EFAST). J Trauma 2004, Aug;57(2):288-95.

No comments:

Post a Comment