17 Extending FAST to eFAST
Lo Zhen Zhen
eFAST includes the thoracic assessment to identify pneumothorax and hemothorax, in addition to the abdominal assessment.
- Identifying Pneumothorax:
- Technique: Utilize a high-frequency linear probe for better resolution. Place the probe in the mid-clavicular line at the second intercostal space, moving laterally along the chest wall.
- Sonographic Signs:
- Normal Lung Sliding: The presence of the ‘sliding lung sign’ (a shimmering motion at the pleural line) rules out pneumothorax at the point of examination.
- Absent Lung Sliding: The absence of lung sliding may indicate a pneumothorax. Look for the ‘barcode sign’ on M-mode.
- B-lines: These are vertical reverberation artifacts that arise from the pleural line and move with lung sliding. Their presence also rules out pneumothorax at that site.
Absent lung sliding in Extended FAST scan. Adapted from “Video 3 Absent Lung Sliding” by International Emergency Medicine Education Project is licensed under CC BY 4.0
B Lines demonstrated during Lung Ultrasound and Extended FAST Scan. Adapted from “Video 6 B Lines” by International Emergency Medicine Education Project is licensed under CC BY 4.0
- Techniques for Assessing Hemothorax:
- Use the curvilinear probe to scan the lateral thoracic cavity, especially the posterior axillary line.
- Hemothorax appears as an anechoic or hypoechoic collection in the pleural space, especially when the patient is lying supine.
Free fluid in the Right Hemithorax, highly suspicious for Hemothorax in context of Trauma. Adapted from “SS Video 22 Small Pleural Effusion” by International Emergency Medicine Education Project is licensed under CC BY 4.0
Integrating These Findings into Trauma Management
The identification of pneumothorax or hemothorax using eFAST is critical in guiding immediate trauma management. A detected pneumothorax may necessitate the placement of a chest tube, while significant hemothorax could indicate the need for surgical intervention. The eFAST findings should be integrated with the overall clinical assessment, including vital signs and physical examination, to make informed and timely management decisions.
| Area | Location & Structures | Objective | Clinical Significance | Scanning Technique |
| Right Upper Quadrant (RUQ) | Between the liver and right kidney (Morison’s pouch) | Detect free fluid accumulation | Fluid indicates potential liver or right kidney injuries. Early sign of hemoperitoneum. | Probe in mid-axillary line below costal margin, marker towards head. Liver as acoustic window. |
| Left Upper Quadrant (LUQ) | Between the spleen and left kidney (splenorenal recess) | Identify free fluid | Fluid suggests possible spleen, left kidney, or related injuries. Fluid often accumulates due to position. | Probe at posterior axillary line, below costal margin, marker cephalad. Spleen as acoustic window. |
| Subxiphoid | Below xiphoid process, pericardial space | Evaluate for pericardial effusion | Detection of fluid can indicate cardiac tamponade, a life-threatening condition. | Probe below xiphoid process, marker to right. Liver as acoustic window. |
| Suprapubic | Pelvic cavity, focusing on the recto-uterine pouch in females and recto-vesical pouch in males | Detect fluid in the pelvic cavity | Fluid in pelvis could be due to bleeding from pelvic fractures or injuries to reproductive or lower abdominal organs. | Probe above pubic symphysis, marker to patient’s right. Bladder as acoustic window. |
| Thoracic (eFAST) | Pleural spaces and lung interface | Assess for pneumothorax and hemothorax | Pneumothorax: Absence of lung sliding indicates possible pneumothorax. Hemothorax: Fluid in pleural space suggests hemothorax. | For pneumothorax: High-frequency linear probe in mid-clavicular line, second intercostal space, moved laterally. For hemothorax: Curvilinear probe along lateral thoracic cavity, especially posterior axillary line. |
