2 - E-FAST

Question 1

Purpose of E-FAST?

Answer 1

Identify free fluid intra-thoracic and intra-peritoneal cavities

Originally only for free fluid
Now used to ID all sonographically detectable pathology

Question 2

Initial diagnostic test of choice in all trauma centers

Answer 2

CT

Question 3

Advantages of the FAST?

Answer 3

Accurate
Rapiud
Noninvasive
Repeatable
Portable
Not nephrotoxic
No radiation

Question 4

Disadvantages of FAST?

Answer 4

• Operator dependent in nature
• Difficult to interpret in obese/gassy pts
• inability to distinguish intraperitoneal hemorrhage from ascites
• cannot eval retroperitoneum

Question 5

Clinical indications for FAST?

Answer 5

Acute blunt/penetrating trauma
Trauma in pregnancy
Pediatric trauma
Subacute torso trauma
Undifferentiated HOTN

Question 6

Fast in blunt trauma pts?

Answer 6

Good for pts who are:

• hemodynamically unstable and cant leave trauma bay
• PE that is unreliable b/c they are intoxicated
• unexplained HOTN

Question 7

When to use FAST in penetrating trauma?

Answer 7

• Immediate surg is not indicated
• in patients w multiple wounds
• uncertain trajectory of bullets

Question 8

Classic PE for acute cardiac tamponade?

Answer 8

• Distended neck veins
• HOTN
• muffled heart tones

Only found in <40% of pts w surgically proven cardiac tamponade

Question 9

E Fast for penetrating trauma?

Answer 9

Stab wounds where superficial muscle fascia has been violated

Negative PE when tangental or lower chest wounds are involved

No CT/Echo available

Question 10

A positive FAST with penetrating trauma can?

Answer 10

Reduce time to

• appropriate consultation
• transfer to trauma center
• definitive surgical tx

Question 11

FAST results flow chart?

Answer 11

POST FAST

• Stable: CT
• Unstable: OR

NEG FAST

• Stable: CT
• Unstable: ??

Question 12

FAST vs X ray for hemothorax?

Answer 12

Upright Chest
- minimum of 100 mL of pleural fluid

Supine Chest
- minimum 175 mL of pleural fluid

US
- minimum of 20mL

Question 13

US pics

Answer 13

23-33

Question 14

More US pics

Answer 14

35-44

Question 15

Sonographically r/o pneumothroax?

Answer 15

Lung sliding

Question 16

Commonly seen artifacts on lungs?

Answer 16

B-lines: comet tailed artifact
A-lines: brightly echogeic lines between rib shadows

Pics on 49-52

Question 17

M mode for pneumothroax

Answer 17

Either:

Normal
- presence of lung sliding (seashore sign)

Pneumo
- absence (stratosphere sign, barcode sign)

Question 18

Lung point sign?

Answer 18

Intermediate sign that is best documented in M-mode

• visualized when lung intermittently contacts the parietal pleura w inspiration
• alternating between seashore and stratospheric signs

Question 19

What allows you to confidently exclude pneumo?

Answer 19

Lung sliding

B lines

Question 20

If you see a lines?

Answer 20

A lines plus absence of lung sliding and B lines is indicative of pneumothorax

95% sensitive
94% specific

Question 21

Lung point sign has

Answer 21

100% specific for occult pneumothorax

Also roughly correlates w the radiographic size of pneumothorax

Question 22

Pneumo pics

Answer 22

54-60

Question 23

What do you get when you cross a vampire and a snow man?

Answer 23

Frostbite