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.
- Rapid (can be performed in <2 minutes)
- Can be performed at the bedside of an unstable patient
- 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
- No radiation
- 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 viewsefast 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
Online resources (a small selection of a myriad)
- Branney SW, Wolfe RE, Moore EE, et al. Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. J Trauma. 1995; 39:375–380
- 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.
- 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