eFAST (Extended Focused Assessment with Sonography in Trauma)

Question 1

Indications de eFAST (3)

Answer 1

Hemodynamically unstable trauma patient

Abdominal and Thoracic Trauma: Blunt (contondant) or Penetrating

Previously stable trauma patient with acute worsening in clinical status

Question 2

Limitations du eFAST (3)

Answer 2

Does not localize the injured abdominal organ

Views may be limited in patients with subcutaneous emphysema

Views may be limited in patients who have a hollow-viscus injury (organes creux) with free air in the abdomen

Question 3

*** 5 étapes de la séquence eFAST

Answer 3

1) Right Upper Quadrant View (RUQ)

2) Left Upper Quadrant View (LUQ)

3) Pelvic View

4)Cardiac View (Parasternal Long Axis or Subxiphoid)

5) Lungs (Right and Left)

Question 4

Différence entre eFAST vs RUSH exam ? Même séquence ?

Answer 4

The FAST Scan is used in the trauma setting to figure out where a patient may be hemorrhaging from. The RUSH Exam on the other hand is a more broad ultrasound protocol used on any patient with undifferentiated hypotension.

RUSH exam n’a pas la même séquence (HI-MAP voir photo)

Question 5

*** 4 questions qui sont répondues par le eFAST

Answer 5

Does my patient have free fluid in the Abdomen?

Does my patient have fluid in the Pericardium?

Does my patient have free fluid in the Thorax?

Does my patient have a Pneumothorax

Question 6

Pourquoi commence-t-on par la vue du QSD ?

Answer 6

Since the liver is the most commonly injured organ in blunt abdominal trauma, the right upper quadrant is usually the most sensitive view of the eFAST exam.

Question 7

Quelles questions (2) sont répondues avec la vue QSD (ou QSG) ?

Answer 7

Does my patient have free fluid in the abdomen or thorax?

** For the right upper quadrant and left upper quadrant views: Remember to look free fluid both above (hemothorax) and below (hemoperitoneum) the diaphragm.

Question 8

ÉTAPE 1 : QSD

• position de la sonde (indicateur vers où ? à la hauteur de quelle côte? sur quelle ligne anatomique ?)

Answer 8

Prendre la sonde comme une pince entre pouce et autres doigts (pince pointe vers céphalique)

Orientate the probe indicator towards the patient’s head.

Anchor your probe in the MIDAXILLARY LINE at the 10th intercostal space.

Question 9

ÉTAPE 1 : QSD

• Qu’est-ce qu’on voit en situation normale ?
• Où trouve-t-on habituellement du liquide dans le QSD ?
• 2 conseils pour bien examiner le QSD

Answer 9

Using the liver as an acoustic window, identify the LUNG , LIVER, MORISON’S POUCH, DIAPHRAGM, and the long-axis of the RIGHT KIDNEY.

*** MORISON’S POUCH (espace hépatorénal) is where you usually identify free fluid in the RUQ view.

POCUS 101 Tip:
- These structures move as the diaphragm contracts and relaxes during the respiratory cycle. Consider asking your patient to hold their breath to keep the desired organs from moving.

• Also, consider slightly rotating the probe counterclockwise towards the bed so that the probe fits better between the rib spaces.

Question 10

ÉTAPE 2 : QSG

• position de la sonde (indicateur vers où ? à la hauteur de quelle côte? sur quelle ligne anatomique ?)

Answer 10

Grasp the linear probe between your thumb and first finger, like holding a pencil.

Orientate the probe indicator towards the patient’s head.

Anchor your probe in the POSTERIOR AXILLARY LINE around the 8th intercostal space.

You should have your “Knuckles to the bed” since the spleen is fairly posterior.

Question 11

Quelles sont les différences de hauteur de côtes et lignes anatomiques entre l’évaluation du QSD et QSG ?

Answer 11

QSD :
- 10e espace intercostal
- ligne midaxillaire

QSG:
- 8e espace intercostal
- ligne axillaire postérieure (jointures sur le lit)

Question 12

ÉTAPE 2 : QSG

• Qu’est-ce qu’on voit en situation normale ?
• Où trouve-t-on habituellement du liquide dans le QSG ?
• 2 conseils pour bien examiner le QSG

Answer 12

Using the spleen as an acoustic window, identify the SPLEEN, PERISPLENIC SPACE, DIAPHRAGM, and the long-axis view of the LEFT KIDNEY.

Free fluid in the LUQ is most frequently seen in the PERISPLENIC SPACE (between the spleen and the diaphragm). The reason is that there is a splenorenal ligament limiting the ability of fluid to track in between the spleen and left kidney.

POCUS 101 Tip:

• These structures move as the diaphragm contracts and relaxes during the respiratory cycle. Consider asking your patient to hold their breath to keep the desired organs from moving.
• Consider slightly rotating the probe clockwise towards the bed, so that the probe fits better between the rib spaces.

Question 13

Quelle est la différence entre les endroits où on retrouve du liquide libre entre QSD et QSG ?

Answer 13

QSD : Morison’s pouch (espace hépatorénal)

QSG : Espace périsplénique (entre RATE ET DIAPHRAGME, pas rate et rein). The reason is that there is a splenorenal ligament limiting the ability of fluid to track in between the spleen and left kidney.

Question 14

ÉTAPE 3 : PELVIS

• Accumulation physiologique de liquide libre pelvien peut être normal chez qui ?
• Vessie vide ou pleine ?
• Profondeur des ondes

Answer 14

• When looking for free fluid in the pelvis it’s important to consider the sex of your patient, as free fluid has a tendency to accumulate in different locations depending on the patient’s gender. Females may have a scant amount of normal physiologic fluid accumulation in the pelvis (pouch of Douglas).
• Ideally, scan your patient with a full bladder (so the bladder can be used as an acoustic window). Therefore, try to initiate the scan prior to foley catheter placement.

Question 15

ÉTAPE 3 : PELVIS

Quelles sont les 2 vues pelviennes à faire dans l’ordre?

Answer 15

1) LONGITUDINALE

2) TRANSVERSE

Question 16

ÉTAPE 3 : PELVIS (vue longitudinale)

• Position sonde pour vue LONGITUDINALE ?
• Profondeur des ondes ?

Answer 16

Place the transducer with the indicator pointing towards the patient’s head in the patient’s midline, right above the pubic symphysis.

Rock the probe so that it points down towards the pelvic cavity (vessie est derrière la symphyse pubienne)

Machine Depth: 10-15 cm

Question 17

ÉTAPE 3 : PELVIS (vue longitudinale)

• Ordre des structures anatomiques à l’échographie pelvienne de l’HOMME
• Où va s’accumuler le liquide libre pelvien ?

Answer 17

In males, identify the bladder (immediately posterior to the symphysis), prostate/seminal vesicle, and RECTO-VESICAL pouch (derrière vésicule séminale) in the longitudinal view.

The rectovesical pouch is where free fluid will accumulate in the male pelvis.

Question 18

ÉTAPE 3 : PELVIS (vue longitudinale)

• Ordre des structures anatomiques à l’échographie pelvienne de la FEMME
• Où va s’accumuler le liquide libre pelvien ?

Answer 18

In Females, identify the bladder, uterus, and RECTO-UTERIN Pouch (also called the Pouch of Douglas).

The Pouch of Douglas is where free fluid will accumulate in the female pelvis.

Question 19

ÉTAPE 3 : PELVIS (vue longitudinale)

• A quel autre endroit recherche-t-on du liquide autant chez l’homme que la femme lors de l’échographie pelvienne ?

Answer 19

In all patients (male or female), observe the lateral borders of the bladder to identify free fluid by tilting/fanning the probe left and right.

Question 20

ÉTAPE 3 : PELVIS

• Comment se rendre à la vue TRANSVERSE à partir de la vue longitudinale?

Answer 20

Center the bladder and then rotate the transducer 90 degrees counterclockwise.

The indicator should now point to the patient’s Right side.

Make sure to tilt the ultrasound probe so it scans into the pelvic cavity.

Question 21

ÉTAPE 3 : PELVIS (vue transversale)

• Ordre des structures anatomiques à l’échographie pelvienne (Femme vs homme)
• Quoi évaluer une fois les structures identifiées ?

Answer 21

In the transverse view, identify the Bladder, Uterus (females), Prostate (males), and Rectum

Tilt/Fan the probe to examine the entire pelvis from superior to inferior.

Question 22

ÉTAPE 3 : PELVIS (vue transversale)

• Une