Bedside Efast Ultrasonography: Extended Focused Assessment With Sonography For Trauma

imagesTo assess for the absence of lung sliding, suggestive of a pneumothorax, in the following conditions:


   imagesBlunt thoracoabdominal trauma


   imagesPenetrating thoracoabdominal trauma


   imagesUnexplained hypotension


imagesTo assess for the presence of pleural fluid, suggestive of a hemothorax, in the following conditions:


   imagesBlunt thoracoabdominal trauma


   imagesPenetrating thoracoabdominal trauma


   imagesUnexplained hypotension


CONTRAINDICATIONS



imagesIf the EFAST examination delays a patient’s transport to the operating room


imagesTheoretical allergy to the ultrasound gel


ADVANTAGES



imagesNoninvasive


imagesNo sedation required


imagesPerformed at the bedside amidst simultaneous resuscitative efforts


imagesDoes not require transportation to the radiology suite


imagesSerial examinations may be performed with changes in symptoms or hemodynamics


LANDMARKS



imagesAnterior Thorax


   imagesThe apical midclavicular line in the sagittal plane; transducer marker positioned cephalad


imagesLateral Thorax


   imagesThe lateral thorax in the axillary region; transducer marker positioned obliquely and cephalad


imagesPleural (Right: Hepatorenal and Left: Splenorenal)


   imagesTransducer 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



imagesThe EFAST standard views in addition to the basic FAST examination:


   imagesBilateral anterior thorax


   imagesBilateral lateral thorax


   imagesBilateral pleural spaces


imagesAnterior Thorax


   imagesPlace the transducer in the second or third intercostal space in the midclavicular line


   imagesThe indicator should be cephalad


   imagesIdentify the bat sign: The upper rib–pleural line–lower rib profile (FIGURE 19.1)


   imagesNormal lung findings


      imagesB-mode: Visible sliding (shimmering or twinkling) at the level of the pleura


      imagesB-mode: Comet tails—vertical reverberation artifacts arising from the pleural line (FIGURE 19.2)


      imagesM-mode: Seashore sign (FIGURE 19.3)


   imagesPneumothorax


      imagesB-mode: Loss of pleural sliding, as there is loss of contact between the visceral and the parietal pleura


      imagesB-mode: Absence of comet tails


      imagesM-mode: Stratosphere sign or bar-code sign (FIGURE 19.4)


      imagesLung point: Transition between collapsed and normally expanded lung; 100% specific for pneumothorax when identifiable


   imagesTABLE 19.1 compares the signs suggestive of normal lung with those of pneumothorax



images


FIGURE 19.1 The bat sign (rib shadow, pleura, rib shadow).

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Bedside Efast Ultrasonography: Extended Focused Assessment With Sonography For Trauma
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