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Learning Objectives
Learn the eFAST Exam (extended focused assessment with sonography for trauma)
Key Points
eFAST used to evaluate trauma in five views: RUQ, LUQ, Pelvis (suprapubic), cardiac (subxiphoid), and lungs
RUQ/LUQ/Pelvis - look for free fluid
Cardiac - tamponade / pericardial effusion in PLAX and subxiphoid view
Lungs - pneumothorax with absent lung sliding and lung point
eFAST Exam (extended focused assessment of free fluid):
Does my patient have free fluid in Abdomen / Pelvis / Thorax? Is there a Pneumothorax?
Transducer: Phased Array (or "cardiac probe")
Position: patient supine
Sequence of Exam:
Right Upper Quadrant (RUQ)
Left Upper Quadrant (LUQ)
Pelvis
Cardiac View (Subxiphoid)
Lung (left and right anterior) - added for "extend" FAST
[RUQ] Probe: pointer towards head, in midaxillary line at 10th intercostal space. Identify lung, liver, Morison's Pouch, Diaphragm and right kidney
Remember- fluid is anechoic (black) on ultrasound!
Free fluid at Caudal Tip of Liver.
Free fluid in Morrison's Pouch and Suprahepatic Space
[LUQ] Probe: posterior axillary line around 8th intercostal space. Identify spleen, perisplenic space, diaphragm, and left kidney.
Free fluid in Perisplenic Space
[Pelvic] Probe: toward head, midline above pubic symphysis. Rock down towards pelvic cavity. Identify Bladder, Prostate/Uterus, and pouch space.
Male - longitudinal view
Female - longitudinal view
Transverse Bladder View: rotate transducer 90 degrees counterclockwise. Indicator should point to patient right side.
Male - transverse view
Female - transverse view
(Male)
Note the anechoic pockets posterior to the bladder
(Female)
Tie-Fighter Sign (free fluid in the pelvis): Note hypo-anechoic area posterior to the bladder. Formed by bladder (anteriorly) and free fluid (posteriorly) flanking the ovarian ligament(females).
[Cardiac] Rule out effusion / cardiac tamponade in PLAX and subxiphoid view. Refer to Cardiac Ultrasound Page
[Lung] Rule out pneumothorax. Refer to Lung Ultrasound Page, with particular attention to lung sliding and lung point sections.
Images / information from: https://www.pocus101.com/efast-ultrasound-exam-made-easy-step-by-step-guide/#eFAST_Ultrasound_Exam_Indications
https://radiopaedia.org/cases/tie-fighter-sign-of-pelvic-free-fluid, https://nephropocus.com/2019/10/28/the-tie-fighter-sign/
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