eFAST
This station covers the Focused Assessment with Sonography in Trauma (FAST/eFAST) exam. The ‘e’ represents the extended FAST exam. The extended exam includes evaluation of the thoracic/lung space to identify pneumothorax or hemothorax. The protocol is designed to detect fluid (blood) in 4 areas:
- Pericardial
- Perihepatic
- Perisplenic
- Pelvic
Considerations:
- Use a low frequency curvilnear probe for the abdomen
- High frequency linear probe for the pleura
- The cardiac phased array probe can be used for the abdomen and subcostal cardiac view.
- Patient is placed supine
- The probe marker should face the patient’s right side of the body. The orientation marker on the display follows the radiology convention and is on the upper left corner of the display. (This is opposite to cardiac scans)
- Start with the subcostal cardiac view. Cardiac tamponade, if present should be dealt with immediately.
- RUQ – Perihepatic.
- Scan with the probe marker facing cephalad in the 10-11th intercostal space, mid-axillary line
- Visualize the liver and kidney
- Morrison’s pouch is the most common location to find fluid in the RUQ. Sweep through the entire length of the kidneys
- Finally move the probe cephalad to look for a pleural effusion (hemothorax)
- LUQ – Perisplenic
- The left kidney is more cephalad and posterior compared to the right
- Scan in the 9-10th intercostal space, posterior axillary line
- Blood is likely to pool around the spleen rather than between the spleen and kidney
- Scan the left hemithorax for hemothorax
- Pelvic
- Start transversely above the pubic bone, with the probe orientation marker facing the patients right
- Sweep the entrie bladder from superior to inferior to identify free fluid
- Turn the probe 90 degrees to scan saggitally. Tilt/sweep the probe the left and right to evaluate the whole surrounding of the bladder
- Fluid most likely accumulates in the rectovesical pouch (males) or ureterovesical pouch (females)
- Thorax
- Evaluate the anterior zones bilaterally for pneumothorax
- Use a linear probe to better visualise the pleura
- M-mode is useful too
Clinical Cases
Make a Diagnosis: Is the FAST scan positive or negative
Clip 1
This is a RUQ scan using a curvilinear probe. A general abdominal scan setting is used, with the display marker on the left of the screen. The liver and right kidney are seen. There does not appear to be any free fluid present.
Clip 2
This is a RUQ scan using a curvilinear probe.The liver is clearly seen, and the whole of the kidney is visible. There is no fluid present in Morrison’s pouch, which is located between the liver and right kidney. The RUQ is negative for free fluid.
Clip 3
This is a RUQ scan using a curvilinear probe. The liver and right kidney are seen. There does not appear to be any free fluid present.
Clip 4
This scan is perfromed with a phased array sector probe. The large anechoic triangular area represents the bladder. There is a fluid located posterior to the bladder, seen on the left of the display just next to the bladder wall.
Clip 5
This is a transverse pelvic scan performed with a curvilinear probe. The bladder is seen in cross-section, as is the uterus posterior to it. There is a significant ammount of fluid in the rectovesical pouch, seen as an anechoic area. This scan is positive for fluid.
Clip 6
This scan is perfromed with a phased array sector probe. There is an anechoic circular well circumscribed area at the upper pole of the kidney. This represents a renal cyst and is not free fluid.
