eFAST exam
A positive FAST is helpful but a negative one…not so much - Andrew Tagg
.jpg)
image by: the_resuscitationist
HWN Suggests
The FAST exam: overused and overrated?
Might the FAST exam be the most overused test in emergency medicine? If not the most overused (it does have to compete with the white blood cell count after all), perhaps it is the most overrated? Considering the sacrosanct position ultrasound holds in emergency medicine, even asking this question might get me in trouble. However, all tests come with risks and benefits. All tests have false positives and false negatives. I have seen numerous patients harmed by seemingly unnecessary FAST exams, and it makes me wonder whether this test (as it is currently being used) is truly providing a net benefit in our patient population.
Resources
Trauma EFAST exams
Scroll through the clips and images at your own pace.
Life in the eFAST Lane: Sonography for Trauma (Part 1)
This is the first of a three part series reviewing the eFAST scan in detail. The goal of this series is to aid new ultrasound users to perform their first eFAST scan correctly and improve existing sonographer’s understanding of the eFAST.
Thinking FAST, and Slow
CT is considered the gold standard for the examination of intra-abdominal injury in children but it is not without risk. As clinicians we are reluctant to expose kids to needless radiation and try and act within the ALARA (As Low As Reasonably Possible) principle. With an increased focus on the use of point of care ultrasound throughout paediatrics it can be tempting to translate the adult approach of using the FAST scan, in kids.
An overview of the eFAST examination in the Trauma setting
There are many hints and tips throughout this video, such as how to work around rib shadowing and how to position the probe with the supine patient and in the subcostal view not only will you look for a pericardial effusion but also how to use this view to assess the patient in cardiac arrest.
Are You Positive... or False Positive? Improve Your Interpretation of the EFAST Exam
Ultimately remember that the EFAST exam is a rule-in test, not a rule-out test - it can rule in free fluid and pneumothorax, but a negative EFAST exam doesn’t rule out injury.
Extended Focused Assessment using Sonography in Trauma (eFAST)
The curvilinear probe is the probe of choice for the eFAST exam as it allows for both adequate penetration and image resolution in all areas examined. This removes any need to switch probes mid-exam.
FAST fails (Things that will mess up your FAST)
5 min Sono Video...
Focused Assessment with Sonography for Trauma
The probe of choice is a phased array probe, as it can achieve adequate penetration while obtaining intercostal windows. If present, a curvilinear probe can also be used for the abdominal portion of the exam. The operator may choose to switch to a linear or high frequency probe for the assessment of pneumothorax in certain cases as it often provides better visualization of the pleural line.
On a FAST track to nowhere at St.Emlyn’s
Should we therefore abandon FAST scanning at level 1 training and change it to something more relevant to us as emergency physicians in the resus room? I think we might, and here are my suggestions for how we might better spend our time…
Podcast 569: The eFAST Exam
While ultrasound is excellent for identifying many injuries, it may not be adequate alone to rule out serious injuries if the clinical suspicion is high based on these pooled studies.
Quick Tips to Improve the eFAST Exam
Most of us working any length of time in emergency medicine are either familiar with or perform the (extended) Focused Assessment of Sonography in Trauma (eFAST). Some keep with the original FAST exam which does not include the lungs,
RUSH Protocol
This is a great tool for evaluation of unexplained hypotension. Most people are familiar with the E-FAST. This protocol uses similar views with additional windows for added diagnostic utility for many types of shock (obstructive, hypovolemic, cardiogenic and distributive).
Trauma Ultrasound
May need multiple windows and probe positions to evaluate ALL perihepatic and perisplenic areas. May need to rotate the probe in between rib spaces to evaluate eliminate rib shadow artifact in the RUQ (counterclockwise rotation) and LUQ (clockwise rotation) views
The FAST exam: overused and overrated?
Might the FAST exam be the most overused test in emergency medicine? If not the most overused (it does have to compete with the white blood cell count after all), perhaps it is the most overrated? Considering the sacrosanct position ultrasound holds in emergency medicine, even asking this question might get me in trouble. However, all tests come with risks and benefits. All tests have false positives and false negatives.
International Emergency Medicine Education Project
The premise behind the eFAST exam is that free fluid accumulates in the dependent areas of the abdomen.
SAEM
You will need to use a low-frequency (3.5MHz) transducer. Many authors recommend using a curvilinear array as this provides excellent intraabdominal views. In practice, some views may be difficult to obtain with this probe due to the patient’s body habitus. Some emergency physicians (EP’s) use a phased-array probe to obtain all images. Not only does it provide excellent cardiac views, it can also provide great intraabdominal views and thoracic/pleural views and saves the time required to switch transducers and re-optimize the settings. Ideally, you’ll have access to a machine with a variety of probes and an easy way to switch from one probe to another.
123 Sonography
Trauma ultrasound was utilised since the 1970s in europe. The FAST protocol was utilised from the mid to late 90s. The addition of the detection of a pneumothorax was included in the eFAST protocol in 2004. The eFAST protocol is a useful tool where we use an ultrasound examination in a trauma setting to detect free fluid, in this case, bleeding. In detection of free intraperitoneal and intrathoracic fluid this protocol has a high specificity and sensitivity, both over 90%.
Merck Manual
The E-FAST examination should be completed in < 5 minutes.
Introducing Stitches!
Your Path to Meaningful Connections in the World of Health and Medicine
Connect, Collaborate, and Engage!
Coming Soon - Stitches, the innovative chat app from the creators of HWN. Join meaningful conversations on health and medical topics. Share text, images, and videos seamlessly. Connect directly within HWN's topic pages and articles.
