E-FAST

Stephanie Doniger, MDEmergency Ultrasound Fellow

St. Luke’s-Roosevelt Hospital CenterFebruary, 2008

FAST

•Blunt trauma

•Penetrating trauma

•Yes/No questions

•Is there free fluid/blood in the abdomen?

•Is there fluid/blood in the pericardium?

E-FAST

•E = extended FAST

•Lung

•Yes/No questions

•Is there fluid/blood in the thorax?

•Is there a PTX?

E-FAST Technique

•Trendelenburg position

•5-10 degrees

•Low frequency probe

E-FAST Views

•Morison’s Pouch

•Splenorenal

•Pelvic

•Pericardial/subcostal

•Thorax

Morison’s Pouch•Most SN

•RUQ

•Ant axillary line

•7th-9th IC space

•Oblique

•Look above diaphragms

Courtesy of http://sinaiem.us

Morison’s: Normal

Morison’s: Abnormal

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Above the Diaphragm

Diaphragm

Liver

Splenorenal

Courtesy of http://sinaiem.us

•LUQ

•Posterior & superior

•Posterior ax line @ 5th-9th IC space

•Oblique rotation (10-20 deg)

Splenorenal: Normal

Splenorenal: Abnormal

Bladder

•Most dependent area of peritoneal cavity

•Best prior to Foley placement

•w/Foley: instillation of saline

Bladder

Courtesy of http://sinaiem.us

•Suprapubic

•TV & Longit views

•Often too superior

Bladder: Normal

Bladder TV: Normal

Bladder: Abnormal

Bladder: Abnormal

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Bladder: Abnormal

Cardiac

•Detection of pericardial fluid

•Subxiphoid preferred

•Alternative: parasternal or apical

Cardiac SX

Courtesy of http://sinaiem.us

•Subcostal

•Probe almost flat

•Use L lobe of liver

•Bent knees

Cardiac: Normal SX

Cardiac: Abnormal SX

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Cardiac: Abnormal PSL

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Lung

•Detection of pleural fluid

•Detection of pneumothorax

•(1) Abdomen: superior to diaphragm

•(2) Lung: pleural interface

Lung

Courtesy of http://sinaiem.us

•3-5 MHz or 5-10 MHz

•Mid-clavicular line

•3rd-5th IC space

•Longitudinal

Lung: Technique

•“Bat-sign”

•Ribs & pleural line

•Landmark to see pleural interface

Lung: Normal

Lung: Normal

Lung•Comet tails

•US bouncing btwn 2 closely spaced interfaces

•Sliding

•Back & forth mov’t pleura w/respiration

•Abnormal: absence of comet tails & sliding

Lung: Comet Tails

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

Lung: Real-Time

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Normal PTX

Courtesy of http://sinaiem.us

Lung: M-Mode

Seashore Stratosphere

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

Questions

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