S

EFASTA Charlies how to guide.

Dr Kyle Kophamel

CME Talk

19th February 2015

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

EFAST

Definition

S Extended

S Focused

S Assessment with

S Sonography in

S Trauma

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

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

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

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

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

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

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

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

EFAST

How does it help?

S Guides Management

S Prioritization

S What should be dealt with first

S Ensures more accurate assessment

S Thoroughness

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?

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

EFAST

Cons

S Low Sensitivity and Specificity

S if the wrong question asked

S Operator dependent

EFAST

Pathology

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

EFAST

Training/Education

S Logbook

S 25-50 supervised scans per module

S Accreditation

S CCPU (ASUM)

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