e-FAST SCAN FOR SURGEONS- Skill Lab- OSCE #e-fastscan #surgicaleducator #babysurgeon #skilllab #osce Subscription Link: http://youtube.com/c/surgicaleducator... Surgical Educator Android App link: https://play.google.com/store/apps/de... Dear viewers, • Greetings from “Surgical Educator” • Today I am uploading one more video on Skill Lab procedure for your OSCE exam. • In this episode, I am talking about the e-FAST Scan, the skill which should be mastered by all medical students. • I hope you can master the skill by watching this video and can do all the steps in the correct sequence. • You can enjoy all my videos in the following link: • youtube.com/c/surgicaleducator • Thank you for watching the video.

1. e-FAST SCAN
(Extended Focused Assessment
with Sonography for Trauma)
SKILL
LAB
OSCE
Dr.B.SELVARAJ
MS;Mch;FICS;
“SURGICAL EDUCATOR”
MALAYSIA

2. e-FAST SCAN FOR SURGEONS
DEFINITION
e-FAST- is used to assess peritoneal, pleural and
pericardial spaces in trauma settings. The primary
application is to find out the pathological free fluid
in these spaces which is blood.
INDICATIONS
1. Rapid evaluation of trauma caused by either
blunt or penetrating injury.
2. To triage and prioritize patients for treatment.
3. Evaluating unexplained hypotension in either
traumatic or nontraumatic settings.

3. e-FAST SCAN FOR
SURGEONS
CONTRAINDICATIONS
1. The only contraindication is the need for
immediate laparotomy
2. Patients with penetrating trauma who are
unstable should be taken directly to the
operating theatre
3. Unstable patients with blunt trauma may
undergo e-FAST to assess the need for
surgery.
4. But if clinical suspicion regarding the need
for exploratory laparotomy is high, the
patient should be taken directly to the
operating room.

4. e-FAST SCAN FOR SURGEONS
EQUIPMENTS
1. e-FAST includes both echocardiographic
and thoracoabdominal examination
2. Ideally performed with a single
transducer that can image all areas with
a 3.5- to 5-MHz curvilinear or convex
array probe
3. Some physicians may choose to use a
phased-array probe due to its better
ability to capture movement.

5. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
 1. Subxiphoid pericardial window
 2. Right upper quadrant and hepatorenal pouch
of Morrison
 3. Left upper quadrant and peri-splenic area
 4. Suprapubic region
 5. Bilateral thoracic views for the evaluation of
pneumothorax and hemothorax

6. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
For intra-pericardial hemorrhage

7. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
1. Subxiphoid pericardial window
1. The examination is done from the right side of
the patient, who is placed supine
2. Direct the transducer under the xiphoid
process, angled cephalad and toward the left
shoulder in a horizontal plane.
3. Apply firm pressure to the body of the
transducer to have it lie flat on the patient’s
abdomen and allow the sound waves to pass
under the xiphoid and into the pericardium.
4. Tilt the transducer to view all four cardiac
chambers and the surrounding pericardium
 Epicardial fat pads move
with the heart during
contraction, whereas
pericardial fluid tends to
remain static.
 Ventricular wall motion and
right ventricular filling
should be evaluated.

8. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
For Intra-peritoneal hemorrhage

9. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
2.Right UPPER QUADRANT

10. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
2.Right UPPER QUADRANT
Any fluid collection within the
hepatorenal pouch would be
noted by a black crescentic
shape on ultrasound.
Place patient in
supine position
Start between 11th and 12th
ribs initially along the
midaxillary line with the
probe indicator directed
cephalad.
Fan the probe from anterior
to posterior abdomen to
evaluate liver, right kidney,
and hepatorenal recess.
The transducer is
oriented as a coronal
section (long axis)
through the midaxillary
line, extending from
the 9th through 12th
ribs.
Normal exam will show bright
line between kidney (K) and
liver (L) with no anechoic
spaces in between.

11. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
3.Left UPPER QUADRANT

12. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
3.Left UPPER QUADRANT
1. Left flank the most difficult examination to
perform during E-FAST
2. Place the patient in the supine position
3. Transducer is directed toward the axilla and
oriented in the coronal plane (long axis)
through the body in the midaxillary to
posterior axillary line extending from the
ninth to twelfth ribs.
4. Transducer is angled cephalad in the long axis
to allow anterior to posterior scanning by
fanning the probe
In Fig 1: a bright line is noted
between the left kidney and
spleen with no anechoic spaces
in between.
In Fig 2: fluid collection
between these two structures
seen as a black crescentic
shape in ultrasound

13. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
4. SUPRA PUBIC AREA

14. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
4. SUPRA PUBIC AREA
Place patient in supine position. The
transducer is oriented in sagittal plane and
placed just above the pubic symphysis and
directed into the pelvis.
Fan the transducer from left to right
to image the bladder and observe
for fluid collections
Turn the transducer to the
transverse position, move to the
right, and place about 1-2 cm
above the pubic symphysis with
the probe angled caudally.
Normal exam will show the
bladder as a large black, fluid-
filled structure; the surrounding
areas external to the bladder
show no anechoic materials.
Surrounding areas external to
the bladder show anechoic
materials.

15. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
5. Bilateral Thoracic Views
Place patient in supine position.
The field depth is set to a lower level to allow proper
visualization of the pleural space between the visceral
and parietal pleurae and evaluation of the pleurae
sliding on one another. Absence of pleural sliding implies
the presence of pneumothoraces.
Probe is placed between the second and fourth
intercostal spaces at the midclavicular line or in the
fourth through sixth intercostal spaces at the midaxillary
line.
Place the transducer in a longitudinal
position, typically between the second
through fourth intercostal spaces along the
midclavicular line. Repeat on the other side
to rule out pneumothoraces in either
pleural space.
To identify pneumothorax, a higher-
frequency linear probe (5 to 12 MHz) is
used for the thoracic examination.

16. e-FAST SCAN FOR SURGEONS
AREAS TO BE
EXAMINED
5. Bilateral Thoracic Views
M-mode illustrating the ‘seashore sign.’/
sandy beach. The pleural line divides the
image in half: The motionless portion
above the pleural line creates horizontal
‘waves,’ and the sliding line below it
creates granular pattern, the ‘sand’
M-mode and the absence of lung sliding
are shown as the ‘stratosphere sign’:
Parallel horizontal lines above and below
the pleural line, resemble a ‘barcode.’ This
sign indicates a pneumothorax at this
intercostal space

17. e-FAST SCAN FOR SURGEONS
TREATMENT ALGORITHM

18. e-FAST SCAN FOR SURGEONS
TAKE HOME MESSAGE
 E-FAST is a non-invasive investigation
that can be rapidly performed at the
bedside of a patient with trauma who is
hypotensive.
 Because it is non-invasive and does not
involve ionizing radiation, E-FAST may be
serially repeated as needed, aiding the
clinician in management decisions.
 The original FAST focused on assessing the
pericardium, the right and left flanks, and
the pelvic region.
 E-FAST expands on FAST by more
thoroughly investigating the pleural
cavities with a high-frequency linear
transducer to look for pneumothorax
 While not sensitive for intraperitoneal
haemorrhage or solid organ injury, the
effectiveness of E-FAST aids in the clinical
decision-making process
 The sensitivity of E-FAST may be
increased with improved operator training
and serial examinations to monitor the
patient for changes.