author: lynette hassall dmu ams mli.
according to the australasian college for emergency medicine (acem), clinician performed bedside ultrasound is a ‘limited, goal directed examination’, designed and used to answer ‘specific clinical questions’. (1)
the indications for performing a fast or efast include:
trauma in pregnancy (2)
it is quick to perform, and should not be used as a ‘stand-alone’ examination – it should be repeated at regular intervals to check the status of the patient.
the clinician performed efast scan is not intended to replace formal diagnostic ultrasound tests, nor is it designed to diagnose solid organ injury or other pathology.
the fast scan should be documented, by saving images of the standard views, plus any additional images to document pathology.
if you cannot see an area clearly, you cannot comment on this part of the examination. 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.
the acem also recommend practical training courses, mentoring and a process of accreditation to ensure that the scans are being performed by clinicians who are competent in this technique.
benefits of performing efast:
decreases the time to diagnosis for acute abdominal injury in blunt abdominal trauma
helps accurately diagnose, and assess degree of haemoperitoneum.
can be integrated into the primary or secondary survey and can be performed quickly, without having to move the patient (or take them to another area).
can be repeated for serial examinations.
is safe in pregnant patients and children.
leads to fewer diagnostic peritoneal lavages. (3)
the efast answers very simple clinical questions:
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?
what constitutes a positive efast?
any fluid visible in any of the potential spaces is abnormal.
loss of the sliding of the lung edge is abnormal.
what next? – your clinical skills dictate course of action