Abstract
Ultrasound has revolutionized our ability to rapidly and noninvasively assess for life-threatening injuries requiring operative intervention in patients who have sustained blunt or penetrating trauma. The Extended Focused Assessment with Sonography for Trauma, or the EFAST exam, allows physicians to look inside the abdomen to assess for hemorrhage, the heart for pericardial effusion or tamponade, and the lungs for pneumo- or hemothorax. In an unstable trauma patient, the EFAST exam will help determine proper disposition including immediate operative intervention vs. further workup such as with computed tomography imaging. This chapter will review indications for performing an EFAST exam, basic anatomy, image acquisition, normal ultrasound anatomy, and interpretation of EFAST pathology.
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RUQ view: Normal RUQ EFAST showing no free fluid. Imaging should include the tip of the liver, area between the liver and right kidney, and views of the diaphragm above the liver (MP4 1838 kb)
Liver tip: RUQ view demonstrating the liver tip above the right kidney. Hemoperitoneum can be detected first around the liver tip; therefore, it is important to image this specific area of the RUQ (MP4 1838 kb)
LUQ view: LUQ EFAST view showing no free fluid. Imaging should include the spleen, area between the spleen and left kidney, and views of the diaphragm above the spleen (MP4 1885 kb)
Paracolic gutters in transverse: Normal pelvis and bladder EFAST view in a transverse plane. Note bilateral paracolic gutters on each side of the bladder (MP4 518 kb)
Sagittal view of the pelvis: Normal pelvis and bladder EFAST view in a sagittal plane (MP4 532 kb)
Subxiphoid EFAST view: Normal EFAST demonstrating a subxiphoid view of the heart. The liver is used as the acoustic widow to view cardiac structures and the pericardium. The right heart sits closest to the liver (MP4 1821 kb)
Lung sliding: Normal EFAST demonstrating lung sliding. Note two anechoic ribs with posterior acoustic shadowing and the hyperechoic pleural line between them (MP4 1343 kb)
IVC view: Normal EFAST view of the IVC as it passes by the liver and drains into the right atrium of the heart (MP4 2411 kb)
Positive EFAST Morrison’s pouch: Free fluid is located within Morrison’s pouch between the liver and right kidney (MP4 1377 kb)
Positive EFAST liver tip: Free fluid is seen here surrounding the liver tip (MP4 1970 kb)
Positive EFAST LUQ: Free fluid is found between the spleen and left kidney (MP4 1984 kb)
Positive EFAST LUQ above spleen: Free fluid is located superior to the spleen and inferior to the diaphragm. Fluid will typically accumulate above the spleen first in the LUQ making it important to always image this area (MP4 488 kb)
Positive EFAST bladder transverse: Free fluid is surrounding the bladder in a transverse plane. Note the anechoic fluid posterior to the bladder and in both paracolic gutters (MP4 555 kb)
Positive EFAST bladder sagittal: Free fluid is surrounding the bladder in the sagittal plane. Note the anechoic fluid around and posterior to the bladder (MP4 1899 kb)
Positive pleural fluid: Free fluid is located superior to the diaphragm within the thorax. Note that there is no free fluid below the diaphragm (MP4 1937 kb)
Large pleura effusion with flag sign: A large amount of free fluid is found within the hemithorax. With large pleural effusions, the lung will appear to be floating in the fluid, creating what looks like a flag flapping in the wind (flag sign) (MP4 2315 kb)
Absent lung sliding: Between two ribs is the hyperechoic pleural line without lung sliding, likely indicating a pneumothorax (MP4 255 kb)
Lung point: Lung point sign is the transition point between normal lung sliding and a pneumothorax with the absence of lung sliding. With a large pneumothorax, lung point sign will not be found (MP4 488 kb)
Pericardial effusion: Parasternal long view of the heart with surrounding anechoic fluid indicating a pericardial effusion (MP4 2434 kb)
Right atrial systolic collapse in tamponade: In cardiac tamponade, the pressure within the pericardium exceeds the pressure within the right atrium causing it to collapse during systole (MP4 776 kb)
Right ventricle collapse: In cardiac tamponade, the pressure within the pericardium exceeds the pressure within the right ventricle causing it to collapse during diastole (MP4 2351 kb)
Plethoric IVC: Here the IVC is visualized passing the liver and draining into the right atrium. Note that there is minimal collapse indicating the IVC is plethoric (MP4 2407 kb)
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Creditt, A.B., Vitto, M. (2018). Extended Focused Assessment with Sonography for Trauma. In: Clinical Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-68634-9_2
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DOI: https://doi.org/10.1007/978-3-319-68634-9_2
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