Objectives
- Understand the goals, applications, and limitations of the focused assessment with sonography in trauma (FAST) exam
- Describe the benefits and limitations of the eFAST exam in the setting of trauma
- Understand the key components and goals of the FAST (the four cardinal views obtained in the abdomen)
- Understand the key components and goals of the extended FAST (eFAST) (the four cardinal views obtained in the thorax)
Next Level eFAST (presented by Dana Resop, MD)
Evaluation:
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Check your knowledge!
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True or False: The FAST is a highly sensitive exam
False!
The sensitivity varies widely, so a normal FAST exam cannot rule out the presence of an abdominal injury
The FAST is highly specific (94-99%) for abdominal free fluid
Name three advantages of the eFAST exam and how it has impacted trauma management
- Brings ultrasound to the bedside– not sending unstable patients to CT scan.
- Reduces time to operative intervention in unstable patients
- Also reduces the time to chest tube insertion
Describe four strategies that can be utilized to evaluate the heart when a distended stomach is obstructing your view
- Ask the patient to take a deep breath and hold
- Rock the probe slightly over towards the patient’s liver
- Switch to the phased array probe (still in the classic subxiphoid approach)
- Switch to the parasternal approach (parasternal long)
Which view of the eFAST view should be obtained first if there is concern for penetrating chest trauma? Why?
Subxiphoid cardiac view
Studies have shown that the cardiac view is 100% sensitive and 97-100% specific for pericardial effusions in penetrating chest trauma
This has been shown to significant reduce the time to operative intervention (~12 minutes!)
This is less meaningful in blunt trauma (diagnostic only in 1 out of 1600 blunt trauma patients)
Which location in the abdomen is most sensitive for detection of intraabdominal free fluid
The inferior (caudal) tip of the liver.
Studies have shown that this location is positive in about 67% of cases.
True or False: the transverse view of the bladder is more sensitive for detecting free fluid than the sagittal view
True!
The transverse view is slightly more sensitive than the sagittal view
Each institution is different. At UW, we only require the sagittal view of the bladder
True or False: The eFAST exam can be utilized outside of the setting of trauma
True!
FAST has been shown to change management in the following situations:
- Ruptured ectopic pregnancy (11%)
- Ascites with concern for SBD (25%)
- Direct/Guides radiology imaging (25%)
- Bedside information for dyspnea, cardiac arrest (medical cases)
True or False: The location of free fluid in the abdomen correlates with the location of injury
False!
Fluid will go wherever the patient is leaning
One study showed that the RUQ was positive in 71% of cases of splenic injuries
Name the spaces where fluid will accumulate in the pelvis
- In males, between the rectum and bladder (rectovesicular space)
- In females, between the rectum and the uterus (rectouterine space, or the ‘Pouch of Douglas’) or between the uterus and bladder
True or False: M-mode may help increase your sensitivity and accuracy for detecting pneumothorax when starting out
True!
When starting out (<250 scans), M-mode has been shown to increase the sensitivity and accuracy for detecting pneumothorax.
Name disease states that can mimic a 'lack of lung sliding' on lung utlrasound
- Apnea
- Severe ARDS
- Pleurodesis
- COPD/ultrasounding over a bleb
So, find the lung point, which is the most specific finding of a pneumothorax on ultrasound.
Name several challenges of using the eFAST exam in pediatric patients.
Kids can hide free fluid really well:
- Up to 30% of children with organ injury have no free fluid
- And 14% of children have free fluid without organ injury
Big takeaway: the eFAST is a specific exam, not sensitive!