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Flashcards in 2 - E-FAST Deck (23):
1

Purpose of E-FAST?

Identify free fluid intra-thoracic and intra-peritoneal cavities

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

2

Initial diagnostic test of choice in all trauma centers

CT

3

Advantages of the FAST?

Accurate
Rapiud
Noninvasive
Repeatable
Portable
Not nephrotoxic
No radiation

4

Disadvantages of FAST?

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

5

Clinical indications for FAST?

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

6

Fast in blunt trauma pts?

Good for pts who are:
- hemodynamically unstable and cant leave trauma bay
- PE that is unreliable b/c they are intoxicated
- unexplained HOTN

7

When to use FAST in penetrating trauma?

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

8

Classic PE for acute cardiac tamponade?

- Distended neck veins
- HOTN
- muffled heart tones

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

9

E Fast for penetrating trauma?

Stab wounds where superficial muscle fascia has been violated

Negative PE when tangental or lower chest wounds are involved

No CT/Echo available

10

A positive FAST with penetrating trauma can?

Reduce time to
- appropriate consultation
- transfer to trauma center
- definitive surgical tx

11

FAST results flow chart?

POST FAST
- Stable: CT
- Unstable: OR

NEG FAST
- Stable: CT
- Unstable: ??

12

FAST vs X ray for hemothorax?

Upright Chest
- minimum of 100 mL of pleural fluid

Supine Chest
- minimum 175 mL of pleural fluid

US
- minimum of 20mL

13

US pics

23-33

14

More US pics

35-44

15

Sonographically r/o pneumothroax?

Lung sliding

16

Commonly seen artifacts on lungs?

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

Pics on 49-52

17

M mode for pneumothroax

Either:

Normal
- presence of lung sliding (seashore sign)

Pneumo
- absence (stratosphere sign, barcode sign)

18

Lung point sign?

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

19

What allows you to confidently exclude pneumo?

Lung sliding
B lines

20

If you see a lines?

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

95% sensitive
94% specific

21

Lung point sign has

100% specific for occult pneumothorax

Also roughly correlates w the radiographic size of pneumothorax

22

Pneumo pics

54-60

23

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

Frostbite