To assess for the absence of lung sliding, suggestive of a pneumothorax, in the following conditions:
Blunt thoracoabdominal trauma
Penetrating thoracoabdominal trauma
Unexplained hypotension
To assess for the presence of pleural fluid, suggestive of a hemothorax, in the following conditions:
Blunt thoracoabdominal trauma
Penetrating thoracoabdominal trauma
Unexplained hypotension
CONTRAINDICATIONS
If the EFAST examination delays a patient’s transport to the operating room
Theoretical allergy to the ultrasound gel
ADVANTAGES
Noninvasive
No sedation required
Performed at the bedside amidst simultaneous resuscitative efforts
Does not require transportation to the radiology suite
Serial examinations may be performed with changes in symptoms or hemodynamics
LANDMARKS
Anterior Thorax
The apical midclavicular line in the sagittal plane; transducer marker positioned cephalad
Lateral Thorax
The lateral thorax in the axillary region; transducer marker positioned obliquely and cephalad
Pleural (Right: Hepatorenal and Left: Splenorenal)
Transducer placed in the axillary line in the coronal plane at the level of 8th and 11th ribs; anterior axillary line on the right and posterior axillary line on the left, with the diaphragm as a landmark; transducer marker positioned toward the axilla.
TECHNIQUE
The EFAST standard views in addition to the basic FAST examination:
Bilateral anterior thorax
Bilateral lateral thorax
Bilateral pleural spaces
Anterior Thorax
Place the transducer in the second or third intercostal space in the midclavicular line
The indicator should be cephalad
Identify the bat sign: The upper rib–pleural line–lower rib profile (FIGURE 19.1)
Normal lung findings
B-mode: Visible sliding (shimmering or twinkling) at the level of the pleura
B-mode: Comet tails—vertical reverberation artifacts arising from the pleural line (FIGURE 19.2)
M-mode: Seashore sign (FIGURE 19.3)
Pneumothorax
B-mode: Loss of pleural sliding, as there is loss of contact between the visceral and the parietal pleura
B-mode: Absence of comet tails
M-mode: Stratosphere sign or bar-code sign (FIGURE 19.4)
Lung point: Transition between collapsed and normally expanded lung; 100% specific for pneumothorax when identifiable
TABLE 19.1 compares the signs suggestive of normal lung with those of pneumothorax