The Extended Focused Assessment with Sonography in Trauma (E-FAST) is a protocolized series of sonographic views that attempt to identify the presence or absence of fluid or air in anatomic potential spaces such as the pericardium, the peritoneum, and the thorax. The goal of this thoracoabdominal survey is to identify or exclude immediate life threats in the trauma or critically ill patient. Although initially intended for the evaluation of the trauma patient, the E-FAST examination and its component views are also extremely valuable in the evaluation of several emergent complaints and clinical conditions including the patient with undifferentiated hypotension.
Trauma (blunt and penetrating)
Unexplained hypotension (traumatic and nontraumatic)
Ectopic pregnancy (to evaluate for rupture)
The FAST examination uses four primary sonographic views to evaluate the patient. It is recommended that all four views are evaluated for a complete exam, but isolated views may be obtained when indicated. The extended component of the FAST exam (termed E-FAST) incorporates imaging of both the anterior and lateral hemithoraces to identify the presence or absence of a pneumothorax or hemothorax (Fig. 24.7). It is important to note that these are not static “single” views, but a series of images obtained in each plane as the transducer is moved or “fanned” through the area of interest.
E-FAST Trauma Series. Ultrasound transducer and probe marker positions for evaluation of pericardial fluid, hemoperitoneum, or pneumothorax. (Illustration contributor: Robinson M. Ferre, MD.)
Views for the E-FAST Examination
Pericardial (usually a subcostal/subxiphoid view—alternatively, one may obtain a parasternal long view of the heart if a subxiphoid view is unobtainable)
Right upper quadrant (RUQ; pouch of Morison)
Left upper quadrant (LUQ) (perisplenic view)
Suprapubic (pelvic view)
The E-FAST exam should be done with the patient in the supine position.
Recommended Transducers for the E-FAST Examination
Convex array (abdominal, cardiac, and lung imaging)
Phased array (abdominal, cardiac, and lung imaging)
Linear array (anterior chest/lung only)
The E-FAST examination is a thoracoabdominal examination. Ideally, this is done using a single transducer that can image all three of these areas, but may result in some compromise of image quality and require the use of different probes for different components of the examination.