E-Fast Examination

E-Fast Examination

1. E – FAST E xtended – Focused A ssessment with Sonography in Trauma Dan stevens , ed registrar scgh

2. Indications Chest trauma Abdominal trauma Others Ectopic pregnancy Ruptured ovarian cyst Ascities Hypotension of unknown cause

3. Limitations Operator dependent High sensitivity and specificity for intraperitoneal fluid Doesn’t tell you what structures are involved Doesn ’ t tell you what the fluid is Significant injuries to structures can occur without free fluid

4. Clinical Questions Is there free fluid? Peritoneal Pericardial Pleural Is there a pneumothorax

5. How to Scan Patient supine Low frequency curvilinear probe Transducer maker Longitudinal Towards head Transverse To patient right (9 O’clock position)

6. Where to scan RUQ LUQ Subxiphoid / subcostal Suprapubic – longitudinal Suprapubic – transverse Right 3 rd to 4 th intercoastal space, mid clavicular line, longitudinal Left 3 rd to 4 th intercostal space, anterior axillary line, longitudinal

7. Right Upper Q uadrant T ransducer C oronally (longitudinally) Marker towards patients head Mid - axillary line Lower ribs Slide, rotate and Fan 4 review areas H epato -renal recess ( M orrisons pouch) Inferior pole of kidney into right paracolic gutter Below diaphragm Pleural cavity

8. Left Upper Quadrant Transducer Coronal plane Marker cephald More superior than RUQ 6 th – 9 th intercostal spaces More posterior than RUQ posterior axillary line 4 review areas Pleural cavity Below the diaphragm ( perisplenic space) Between spleen and left kidney Inferior pole left kidney (left paracolic gutter)

9. Subxiphoid / Subcostal – 4 chamber view Transducer Transverse, marker to patients liver Subxiphoid Directed towards patietns left shoulder Liver as acoustic window May need to increase depth Effusion = dark band (anechoic), that separates bright ( hyperechoic ) pericardium from heterogenous grey myocardium

10. Suprapubic - Long Transducer M idline Marker towards patients head Caudal end of probe just superior to pubic symphysis Fan left to right Review area s Men 1. rectovesical space Women 1. vesicouterine space 2. rectouterine pouch (pouch of Douglas)

11. Suprapubic - Trans Transducer Midline Transverse Marker towards patients right Fan superior to inferior Review area Posterior wall of bladder

12. Lung - Right Mid-clavicular line Transducer Curvilinear (abdominal) Linear (vascular access) Longitudinal Marker towards patients head Reduce depth 3 rd - 7 th intercostal space (most superior) mid-clavicular line Review areas Marching ants Comet tails A lines

13. Lung – Left A nterior A xillary line Transducer Curvilinear Linear Longitudinal 3 rd – 4 th intercostal space Anterior axillary line M-Mode Waves at sea Waves at the beach

14. References http:// www.ultrasoundvillage.com Bedside Ultrasound. Volume 1 Dawson, Mallin Point-of-Care Ultrasound. Soni , Arntfield , Kory