There are numerous outstanding emergency point of care ultrasound videos on YouTube. I recommend starting with the three YouTube videos created by critical care specialist Liz Turner, MS, MD: the eFAST exam, the FATE exam, and the RUSH exam. Today we’ll watch the eFAST exam video.
All that follows is from Dr. Turner’s video:
The eFAST exam is the extended Focused Assessment of Sonography in Trauma. This exam protocol consists of five sonographic views:
- the two chest windows which use the high frequency probe to look for pneumothorax
- the subcostal view of the heart
- the parasternal long axis view of the heart
- the right upper quadrant view to assess for fluid in the right hemi-thorax and in Morrison’s pouch, and the left upper quadrant view to look for fluid in the left hemi-thorax and the spleno-renal pouch.
- and the pelvic view to look for pelvic fluid.
The indications for eFAST are:
- Blunt and penetrating thoracic or abdominal trauma,
- trauma or abdominal pain in a pregnant patient,
- or unexplained hypotension in any patient.
The contraindications to an eFAST exam: Clear and identifiable need to go to the OR
The eFAST exam is much faster than CT scan and much more reliable than the physical exam (peritoneal lavage is no longer used).
With the eFAST exam we are looking for hemopericardium, hemoperitoneum, hemothorax, and pneumothorax.
In the left upper quadrant you are looking for the spleno-renal recess. And typically we have to go more posterior and superior [meaning cephalad] to get this view. When you are looking at Morrison’s pouch you are using the mid-axillary line. [On both sides the probe is in the coronal plane.] But when you are looking at the speno-renal recess you often have to put your knuckles completely on the bed and angled up to see the spleno-renal recess.