Consultant Topic Champions: Luke Phillips
Registrar Topic Champions:
Extended Focused Assessment with Sonography for Trauma (eFAST) is used to identify free fluid within the abdominal cavity (excluding retroperitoneal space), pericardial fluid and pneumo/haemothoraces. It can aid rapid decision making in extremely unwell trauma patients and has become standard of care in the primary survey assessment of trauma patients around the world.
ACEM recommends that you have expert level skills in performing eFAST on completion of your training and also recommends practical training courses, mentored scans and a departmental accreditation process to ensure that the scans are being performed by clinicians who are competent in this technique.
The indications for performing an eFAST include:
- Blunt trauma
- Penetrating trauma
- Unexplained hypotension (Suspected ectopic/AAA/Bleeding Ulcers etc)
- Trauma in Pregnancy
The simple clinical questions that eFAST answers include:
- Is there significant free fluid in the pericardial cavity?
- Is there free fluid in the peritoneal cavity?
- Is there free fluid in the chest cavity?
- Is there a pneumothorax (loss of lung sliding)?
The eFAST is not designed to diagnose solid organ injury or other pathology and it should be repeated at regular intervals to check the status of the patient. If an area is not visualised clearly then you cannot comment on this part of the examination.
The eFAST scan should be documented, by saving images of the standard views, plus any additional images to document pathology.
The decision on treatment path for the patient is then made on your physical examination, whether the patient is stable or not, the results of other tests, and your clinical opinion. It does not rest alone on what the ultrasound shows.
Learning & Accreditation Process
Accreditation of eFAST within the department will involve:
- Completion of online learning module through UTEC (Geelong ED Sign on code = GORUS) or have completed an accredited course.
- Attend departmental workshop.
- Completion of a logbook of 25 scans which will include 3 positive scans and at least half of the 25 scans should be clinically indicated. Revise ASUM CCPU guidelines & minimum imaging set here
- 2 formative assessments and 1 summative assessment by an ED consultant. Form available for online completion (Smart phone/Tablet compatible).
- CCPU formative and summative assessment forms are at the end of this document if required.
- Ongoing credentialing requirements include at least 3 hours of Ultrasound training per year as well as 25 logbook scans over a 2 year period.
Minimum Imaging Requirements
The examination involves a minimum of six views including:
- Right Upper Quadrant including the hepato‐renal interface (Morison’s pouch) and the right diaphragm. Images must include liver tip. (Recording of a video loop recommend for the view)
- Left Upper Quadrant including the spleno‐renal interface and left diaphragm.
- Transverse and long views of bladder/pelvis
- Subxiphoid or intercostal views of the pericardium.
- The left and right parasternal views to detect lung sliding (either video or M-Mode)
Review the image library at the Ultrasound Village that outline normal and some abnormal images.
Minimal documention requires
- E-Fast Performed by Me. The Scan was -ve/+ve
- Adequate Views
- No/Large/Medium/Small Volume Intra-abdominal free fluid & describe location if fluid identified
- Chest: No/+ve Pneumothorax/Haemothorax (describe Volume)
- No/+ve Pericardial effusion (Describe volume and features if any of tamponade)
- Copies of images have been saved to machine for export.