The Case: There are just too many eFAST cases to choose from. Which one to tell you…? Should I tell you about my first eFAST patient, the supposed-to-be-simple-but-really-wasn’t, on-coumadin guy who laid out his motorcycle? What about the lady from the rollover down a twenty foot embankment? Or the teenager from a horseback riding accident? Should I tell you about the night I hung out in resuscitation and did an eFAST on every patient that came through? A night in December I like to think of as Ultrasound Christmas. A night when a trauma alert rolled in and before I knew what was happening, the resident put the ultrasound probe in my hand and said “Go for it!” Needless to say it was AWESOME! Like do-a-secret-happy-dance-in-the-hallway-afterwards kind of awesome. I’m definitely still lovin’ the ultrasound elective, especially since I’ve become competent at eFASTs.
So what’s an eFAST you ask? It’s simple, really. It’s a systematic ultrasound scan to check for pneumothorax and free fluid (usually blood) in the abdomen and chest. It’s quick, easy, and incredibly useful. You don’t have to be a genius for this stuff. And it’s an ultrasound scan, so it means fewer patients being radiated by CT scans. Remember? Radiation bad. No radiation good. If you’re going to spend time in the ED, you should learn the eFAST. End of story. Plus if trauma’s your scene, you’ll get close to some wicked traumas. So now that you’re convinced… just how do you do an eFAST?
What’s eFAST All About?
The eFAST is a fast (pun intended) and easy way to check for blood in the chest and abdomen. eFAST is an acronym for extended Focused Abdominal Scan for Trauma. It’s an ultrasound exam designed for trauma patients that can be used at the bedside without interrupting ongoing care. Unstable patients with positive eFAST scans can then receive definitive care (get a chest tube, go to surgery, etc.) without the delay of waiting for a CT. The exam is a set of scans that quickly visualize free fluid (like blood) in the anatomical sites it most commonly collects, so the trick to quickly interpreting an eFAST exam is learning just where free fluid tends to collect. An eFAST looks at the right upper quadrant (RUQ), left upper quadrant (LUQ), pelvis, heart, and lungs. (Lungs are the extended part of the exam. Without the lung component it’s just called a FAST exam.) So that’s five ultrasound views, six if you’re picky about the whole 2 lungs thing, and you’ve completed an eFAST exam. It takes less than 5 minutes to complete, but more like 2 minutes as you approach ultrasound rock star status. Plus it’s more sensitive than x-ray for conditions like pneumo or hemothorax. Basically, eFASTs are a great ultrasound scan for rapidly identifying bleeding and other common injuries in the trauma patient.
The Patient: Who Gets an eFAST?
- Blunt and penetrating abdominal trauma
- Blunt and penetrating chest trauma
- Ectopic Pregnancies
- Suspected abdominal or thoracic free fluid or active bleeding
How Do I perform an eFAST?