eFAST

Extended Focused Assessment with Sonography in Trauma

The aim of eFAST is to rapidly identify life-threats in unstable trauma patients as part of the primary survey.

Ultrasound is increasingly being performed on stable patients – this can confirm clinical impressions and can be useful as a baseline if the patient deteriorates.

 

Advantages

  • Rapid (can be performed in <2 minutes)
  • Can be performed at the bedside of an unstable patient
  • Reliable
    • A trained user should be able to detect at least 200ml of free intraperitoneal fluid 1
    • Around 90% sensitive for the detection of haemoperitoneum and very specific (98-100%) 1
    • Is probably more sensitive than supine CXR in detecting pneumothorax2
  • Reproducible/repeatable
  • Non-invasive
  • No radiation

 

Disadvantages

  • CT more sensitive in detecting haemoperitoneum (nearly 100%)
  • Low sensitivity in detecting organ specific injury
  • Cannot assess retroperitoneal injuries
  • Can be challenging in obese patients
  • Operator dependent

 

There are SIX key views

efast table

 

Other used for ultrasound in trauma include

  • Peripheral and central venous line placement in stable patients (if unstable, place an intraosseous line if peripheral venous access not immediately obtainable)
  • Check for fetal heart beat in pregnant trauma patients
  • Ultrasound guided nerve blocks
  • Can be used to detect fractures or dislocations

 

It is highly recommended that all trauma practitioners attend an accredited ultrasound eFAST course

 

Online resources (a small selection of a myriad)

 

https://www.acep.org/Clinical—Practice-Management/Focus-On–EFAST—Extended-Focused-Assessment-With-Sonography-for-Trauma/

 

http://www.ultrasoundpaedia.com/fast-scan/

 

https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/274207/2-efast.pdf

 

 

 

References

 

  1. Branney SW, Wolfe RE, Moore EE, et al. Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. J Trauma. 1995; 39:375–380

 

  1. Hoff, William S., et al. “Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group.” Journal of Trauma and Acute Care Surgery3 (2002): 602-615.

 

  1. Gentry Wilkerson, R., and Michael B. Stone. “Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.” Academic Emergency Medicine1 (2010): 11-17. http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2009.00628.x/full

 

About this guideline

Published: January 2018

Author: Emma Batistich

Approved by: Northern Region Trauma Network, ADHB, WDHB, CMDHB, NDHB

Review due: 2 years