eFAST

Clinical Indications

The indications for performing an eFAST include:

  • Blunt trauma
  • Penetrating trauma
  • Unexplained hypotension (Suspected ectopic/AAA/Bleeding Ulcers etc)

The simple clinical questions that eFAST answers include:

  • Is there significant free fluid in the pericardial cavity?
  • Is there free fluid in the peritoneal cavity?
  • Is there free fluid in the chest cavity?
  • Is there a pneumothorax (loss of lung sliding)?

Views

  1. RUQ (including Morison’s Pouch, tip of liver and base of right hemithorax)
  2. LUQ (including lienorenal space, tip of spleen and base of left hemithorax)
  3. Transverse and longitudinal pelvis
  4. Video Clip of Cardiac (subcostal or other window that clearly demonstrates posterior pericardium)
  5. Anterior right lung and left lung (cineloop or M-mode that clearly demonstrates presence or absence of lung sliding)

Documentation

  1. Scan +ve or -ve
  2. Adequacy of Images
  3. Presence of free fluid and Location noted
  4. Presence / Absence of Pneumothorax
  5. Presence / Absence of Pericardial Effusion

Credentialling Requirements

  1. Completion of Accredited Course, ACEM Online module or Online Training Module (UTEC)
  2. Attend our ED eFAST Workshop or arranged 1-on-1 sessions with members of US-SIG.
  3. 25 eFAST scans, including 5 positive [free abdominal pleural or pericardial fluid, or pneumothorax] not necessarily directly supervised.
  4. All cases must be compared with gold standard findings (such as comprehensive imaging, pathological findings or if these are unavailable then clinical course).
  5. 2 Formative scans supervised by ED Consultant and 1 Summative eFAST scans completed using provided assessment forms.
  6. These assessments can also double as your ACEM Core-DOPS.
  7. Ongoing requirements  of 25 eFAST scans over a 2 year period.

Definition of Sonologist

 A sonologist is used to include practitioners who have successfully completed this credentialing process or equivalent (DDU, Radiologist, DMU or AMS or sonographer registered with NZ MRTB in the relevant field, CCPU in the relevant field, PGCert / Dip of Clinical Ultrasound).

Resources

Introduction to Bedside US Volume 1 and 2 by ultrasoundpodcast.com

EFAST Video by 5MinSono