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

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