Including EFAST in Trauma Algorithms: When? What Now?

Neither detection of injured organs nor a precise diagnosis is required for decision
The key point on which to apply EFAST findings is patient physiology
All lesions not “producing” free fluid will not be in the range of EFAST: if you suspect them, go ahead with your further step

5.2 The Common Role of US Exam in Trauma

The “golden hour” paradigm is not a strictly clock-related concept but means an evidence increasing of morbidity and mortality if care is delayed beyond the first hour after injury.

So a quick examination like focused sonography found a kind of a natural place in the primary evaluation of traumatized patient, both in hospital and in prehospital settings.

The first aim of EFAST is to assist in assessing the undifferentiated hypotensive status secondary to a blunt trauma.

It could be also selectively applied in the evaluation of penetrating torso trauma.

For its “focused” nature, EFAST sonography has some limits which must be known.

Specificity is high. So, if my EFAST is positive, I could be sure there is an effusion (abdominal, pericardial, or thoracic), and these results must be related with the clinical condition of the patient.

Sensitivity depends on my skills, the patient, and time from trauma. So, if my EFAST is negative, it is very important to be very sure about my images and interpret them cautiously in both blunt and penetrating traumas, because the presence of an underlying lesion in abdominal trauma is not always related with free fluid, especially in the early period.

Some lesions don’t produce free fluid (retroperitoneal bleeding, intraparenchymal lesions); others sometimes require time to develop effusion (bowel injuries, for instance).

When we performed a focused sonography examination in trauma setting, we do a particular sonography with a particular point of view.

Taking in mind the basic ATLS method of assessing a trauma patient, which is valid for both major and minor traumas, it will be not so difficult to realize and agree what is depicted in the box above.

EFAST applies to thoracic and abdominal trauma
The choice of the sequence of scans is mostly dependent on the patient’s trauma status and mechanism
EFAST should be performed
- During the primary survey in physiologically unstable patients
- At the end of primary survey in normal and stable patients
- During the secondary survey and whenever needed by changes in patient clinical status
EFAST refers to B and C steps of the primary survey

5.3 Common Algorithms

Simple algorithms including EFAST and its meaning for clinical decision in blunt and penetrating trauma are shown below. Brief comments are given for each one in order to explain some points of the flow chart.

Before taking a look at them, please consider that: