Flashcards in 2 - E-FAST Deck (23):
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
Initial diagnostic test of choice in all trauma centers
Advantages of the FAST?
Disadvantages of FAST?
- Operator dependent in nature
- Difficult to interpret in obese/gassy pts
- inability to distinguish intraperitoneal hemorrhage from ascites
- cannot eval retroperitoneum
Clinical indications for FAST?
Acute blunt/penetrating trauma
Trauma in pregnancy
Subacute torso trauma
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
When to use FAST in penetrating trauma?
- Immediate surg is not indicated
- in patients w multiple wounds
- uncertain trajectory of bullets
Classic PE for acute cardiac tamponade?
- Distended neck veins
- muffled heart tones
Only found in <40% of pts w surgically proven cardiac tamponade
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
A positive FAST with penetrating trauma can?
Reduce time to
- appropriate consultation
- transfer to trauma center
- definitive surgical tx
FAST results flow chart?
- Stable: CT
- Unstable: OR
- Stable: CT
- Unstable: ??
FAST vs X ray for hemothorax?
- minimum of 100 mL of pleural fluid
- minimum 175 mL of pleural fluid
- minimum of 20mL
More US pics
Sonographically r/o pneumothroax?
Commonly seen artifacts on lungs?
B-lines: comet tailed artifact
A-lines: brightly echogeic lines between rib shadows
Pics on 49-52
M mode for pneumothroax
- presence of lung sliding (seashore sign)
- absence (stratosphere sign, barcode sign)
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
What allows you to confidently exclude pneumo?
If you see a lines?
A lines plus absence of lung sliding and B lines is indicative of pneumothorax
Lung point sign has
100% specific for occult pneumothorax
Also roughly correlates w the radiographic size of pneumothorax