EFAST - A how to guide
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EFAST - A how to guide
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EFAST - A how to guide
- 1. S EFAST A Charlies how to guide. Dr Kyle Kophamel CME Talk 19th February 2015
- 2. Objectives S Overview of the the EFAST Scan S Use in Trauma S Advantages and limitations S Demonstrate Technique S Normal and abnormal scans S Training and Accreditation
- 3. EFAST Definition S Extended S Focused S Assessment with S Sonography in S Trauma
- 4. EFAST How can we use it? S Clinical Examination S Answers specific Questions S Is there free fluid in the abdomen? S Is there free fluid in the pericardium? S Is there evidence of a pneumothorax/haemothorax? S Guides management
- 5. EFAST How’s it performed? S Real time Views S Abdominal S Perihepatic/RUQ S Perisplenic/LUQ S Pelvic (Long and Trans) S Cardiac S Pericardial (usually subcostal) S Thorax S RUQ S LUQ S Parasternal
- 6. EFAST Views S Perihepatic/RUQ S Probe in longitudinal orientation S Lower ribs of right chest wall S Mid-axillary line slide posteriorly S Morrisons Pouch S Subdiaphragmatic space S Right costo-phrenic angle
- 9. EFAST Views S Perisplenic/LUQ S Longitudinal Probe orientation S Mid to post axillary line S Often more posterior view with deep inspiration S Leino-renal space S Perisplenic S Left costo-phrenic angle
- 12. EFAST Views S Pelvic S Just above symphysis pubis S Transverse and Longitudinal probe orientation S Female vs Male S Pitfalls S Bowel fluid S Empty Bladder
- 17. EFAST Views S Pericardial View S Left Subcostal probe position S Angled under ribcage, towards left shoulder S Pitfalls S Pleural effusions S Pericardial fat pad
- 20. EFAST Views S Lung S Most anterior chest spaces in supine patient S Parasternal, longitudinal S Bat shape S Lung sliding (“trail of ants”) S Lung comets (Presence excludes PTx) S PTx S Loss of lung sliding S Lung point sign
- 21. EFAST What does is mean? S Free fluid is anechoic/sonolucent (Black) and has angularity to it’s margins (ie. takes the shape of it’s container) S Clot appears echogenic S Cannot differentiate fluid types S Clinical context is important (+/- diagnostic aspiration) S Generally require greater than 100-250mls free fluid S Dependent on bladder fullness/patient size/sonographer skill
- 22. EFAST How does it help? S Guides Management S Prioritization S What should be dealt with first S Ensures more accurate assessment S Thoroughness
- 23. EFAST How does it not help? S Wrong questions S Is there any intraperitoneal bleeding? S Is there any intra-abdominal injury? S Can I send the patient home?
- 24. EFAST Pros S Rapid and Bedside S Non-Invasive S Repeatable S High sensitivity and specificity S Depends on the question being asked/answered S Consider it as part of Primary survey S Chest = CXR S Abdomen = FAST
- 25. EFAST Cons S Low Sensitivity and Specificity S if the wrong question asked S Operator dependent
- 26. EFAST Pathology
- 32. EFAST Training/Education S http://scghed.com/ed-orientation/ultrasound-where-do-i-start/ S Basic Ultrasound Course S US Physics/Essentials S AAA S EFAST S Vascular Access S BELS S DVT
- 33. EFAST Training/Education S Logbook S 25-50 supervised scans per module S Accreditation S CCPU (ASUM)
- 35. References S www.ultrasoundvillage.com S thesonocave.com S www.asum.com.au/newsite/Education.php?p=CCPU S www.lifeinthefastlane.com/ccc/pneumothorax-ultrasound/ S www.lifeinthefastlane.com/trauma-tribulation-019/ S Fildes J, et al. Advanced Trauma Life Support Student Course Manual (8th edition), American College of Surgeons 2008 S Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014 Jan 9;4(1):1. doi: 10.1186/2110-5820-4-1 S Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995 Nov;108(5):1345-8
Notes de l'éditeur
- Provides an extension of the normal clinical examination in a trauma setting Asks a specific question and gives a specific answer The answers to these questions can then be interpreted to guide management
- Bowel fluid is round – but free/dependant fluid has sharp demarcartion
- Look for fluid between the pericardium and the heart
- High specificity High sensitivity – user dependant Better sensitivity than supine CXR Not as good as CT
- Blood/Urine/Ascites look the same – especially to the untrained eye! Clinical context is important
- Examine and reexamine to ensure that nothing is missed. Advantage of serial EFAST