EFAST Exam Overview

Introduction

• Presenter: Jared Marks from POCUS Geek
• Topic: The EFAST (Extended Focused Assessment with Sonography for Trauma) Exam
• Purpose: Evaluating trauma patients who are hypotensive and critical, assessing for hemoperitoneum or shock causes.

Importance of the EFAST Exam

• Crucial for evaluating trauma patients in emergency settings.
• Helps in evaluating critical care patients and has led to the development of other critical care protocols.
• Useful in both trauma and certain medical patients, especially those who are hypotensive or in respiratory distress.

Equipment & Setup

• Recommended Probe: Curvilinear probe (low-frequency) for evaluating all necessary areas.

Indications for Use

• Trauma Patients: Especially useful in hypotensive, tachycardic, or respiratory distress cases.
• Penetrating Trauma: Evaluates pneumothorax and pericardial effusion.

Examination Process

1. Binary Questions: Focus on finding free fluid (pleural space, diaphragm, liver, kidney).
2. Clockwise Method: Start in the right upper quadrant, move clockwise around the abdomen.
3. Areas of Interest:
   • Right Upper Quadrant: Diaphragm, pleural space, liver, kidney.
   • Morrison’s Pouch: Evaluate for fluid.
   • Left Upper Quadrant: Spleen, diaphragm, kidney.
   • Pelvis: Bladder, prostate (males), uterus (females).
   • Thorax: Evaluate for free fluid and lung sliding.

Detailed Examination Steps

• Right Upper Quadrant:
  • Evaluate pleural space and diaphragm.
  • Continue to liver and kidney for free fluid.
• Subxiphoid Area:
  • Evaluate the pericardial sac and heart.
  • Potentially switch to phased array for detailed cardiac exam.
• Left Upper Quadrant:
  • More challenging due to small spleen size.
  • Evaluate pleural space to inferior pole of spleen and kidney.
• Pelvic Examination:
  • Identify bladder, prostate (males), uterus (females).
  • Look for free fluid intraperitoneally.

Cardiac and Thoracic Evaluation

• Cardiac Function: Assessed through pericardium and myocardial walls.
• Lung Evaluation:
  • Assess for lung sliding (indicates absence of pneumothorax).
  • Use mid-clavicular line and evaluate each intercostal space.

Key Points

• Most Sensitive Area: Right upper quadrant for free fluid.
• Consider Patient Position: Pelvis evaluation may be prioritized if patient was upright.
• Binary Questions: Focus on free fluid presence, cardiac function, and lung sliding.

Additional Information

• Further learning on cardiac ultrasound and lung points available in other lectures.
• Advice on probe switching and examination flow.

Conclusion

• Contact: [email protected] for questions.
• Resources: Links to additional videos and materials.