eFAST

by Ashley Bean and Gregory R. Snead

Introduction

The objective of the extended focused assessment for sonography in trauma (eFAST) is to detect free fluid in the peritoneal, pleural and pericardial spaces, and also to detect free air in thoracic cavities. In the setting of trauma, we assume this fluid is blood; however, it can be urine or bowel contents as a result of organ rupture or it can be pre-existing ascites. An eFAST exam should take less than 5 minutes to complete.

In the peritoneal cavity, 200 ml of fluid can be detected via ultrasound in the ideal patient. In reality, however, the smallest detectable amount is usually around 500 ml. Hypotensive trauma patients with free abdominal fluid need urgent operative intervention. (Protocol 1) If there is not a surgeon who can repair abdominal and cardiac injuries at your institution, transfer the patient to a facility with this capability. A stable patient with free intraabdominal fluid should undergo further diagnostic testing such as CT to ascertain the specific injury.

While peritoneal lavage has been traditionally utilized to evaluate for intraabdominal blood in the hypotensive trauma patient, the eFAST exam offers several advantages over peritoneal lavage. The eFAST exam is non-invasive, repeatable, rapid and sensitive for injuries requiring surgical intervention. It also does not interfere with computed tomography (CT) interpretation. Rozycki et al. reported that the FAST exam was shown to be 100% sensitive and 100% specific for hypotensive blunt abdominal trauma patients. Conversely, peritoneal lavage is invasive, can only be performed once, may require laboratory processing and has a high false positive rate. Peritoneal lavage may also confound interpretation of abdominal CT imaging.

Rapid detection of pericardial tamponade and cardiac injuries is of critical importance in the trauma patient. Fortunately, ultrasound is very sensitive for the detection of pericardial fluid. As little as 10 to 20 ml of fluid can be readily identified in the pericardium. In one of the original studies on the FAST exam, pericardial fluid had a sensitivity of 100% and a specificity over 99% for cardiac injury. Therefore, trauma patients with a pericardial effusion have a presumed cardiac injury requiring evaluation in the operating room. (Protocol 2)

Hypotensive trauma patients who do not have free fluid in their abdominal, pericardial, or plural spaces should be investigated for further injury. For instance, the patient may have spinal shock, a long bone fracture causing blood loss, or lost a significant amount of blood at the scene of the trauma. Other non-traumatic causes should also be considered such as myocardial infarction. Another possibility is that there is not yet a large enough amount of blood to be detected by the eFAST exam in which case, the eFAST should be repeated.

Case Presentation

A 40-year-old man involved in a car crash presents to your emergency department by ambulance. His vital signs are pulse 118 beats/minute, blood pressure 80/45 mmHg, respiratory rate 30 breaths/minute, oxygen saturation 98%, and temperature 37C. He is awake and oriented, complaining of epigastric abdominal pain and difficulty breathing.

The following images are obtained.

Normal Subcostal Cardiac 4 chamber viewImage 1: Subcostal Cardiac

 

Right Upper QuadrantImage 2: Right Upper Quadrant

 

Left Upper QuadrantImage 3: Left Upper Quadrant

 

Suprapubic viewImage 4: Suprapubic

After 1 Liter of normal saline, the patient remains hypotensive and is transferred to the operating room where he undergoes a midline laparotomy. A spleen injury is identified intraoperatively.

Procedure

The premise behind the eFAST exam is that free fluid accumulates in the dependent areas of the abdomen. An extended FAST exam involves several views. These are;

  1. Subcostal or Parasternal Long Axis Cardiac
  2. Right Upper Quadrant
  3. Left Upper Quadrant
  4. Suprapubic
  5. Thorax for Hemothorax and Pneumothorax
  6. IVC for volume status

Perform either a subcostal view or parasternal long axis view of the heart to look for pericardial effusion or tamponade. Views of the abdomen include the right and left upper quadrants as well as a suprapubic view. Image each hemithorax for the presence of hemothorax or pneumothorax. Finally, the inferior vena cava is imaged to estimate the patient’s volume status. While performing the exam, we ask four yes/no questions. These are;

  1. Is there fluid in the peritoneal cavity?
  2. Is there a pericardial effusion?
  3. Is there fluid in the thorax?
  4. Is there a pneumothorax?

Emergency Indications

Indications for the eFAST include both blunt and penetrating traumatic injuries as well presentations of unexplained hypotension as part of an ultrasound shock protocol (i.e., RUSH exam) to rapidly diagnose the cause of low blood pressure.

Contraindications

Contraindications to the eFAST are primarily situations in which performing the study would delay or interfere with critical life-saving interventions including emergent surgical intervention.

Equipment and Patient Preparation

Ultrasound equipment should be readily available in the emergency department setting. Machines should have low-frequency probes (2-5MHz) that may be either curvilinear or phased array in design (Image 5, 6). A high-frequency linear probe (5-10MHz) (Image 7) may also be used to aid diagnosis of pneumothorax in challenging cases and are preferred by some practitioners. Higher frequency curvilinear or phased array probes may be advantageous in pediatric cases. All machines should have the capability of image capture, preferably in digital format.

Curvilinear TransducerImage 5: Curvilinear Transducer

 

Phased Array TransducerImage 6: Phased Array Transducer

 

Linear TransducerImage 7: Linear Transducer

Prior to patient arrival, the ultrasound machine should be positioned to the left of the trauma bed and a patient identifier placed for the exam along with probe and study type selection (Image 8). Ultrasound gel should be stocked on the machine at all times. Following the primary survey, sufficient ultrasound gel should be applied to the epigastrium to facilitate all views. Please do not forget, ultrasound gel is cold. Therefore, awake patients should be informed. The exam should then be performed to include the recording of appropriate images and video clips.

Ultrasound and Patient Bed PositionImage 8: Ultrasound Position

 

Transducer Orientation

Each transducer has a marker, which is oriented in the same direction as the probe marker indicator on the screen. For all of the views of the eFAST exam, except the parasternal long axis cardiac view, the probe marker should be pointed either towards the patient’s head or right side. When the transducer marker is point towards the patient’s head (longitudinal orientation), the patient’s head will be toward the left side of the screen, and their feet will be toward the right side of the screen. When the probe marker is pointed to the patient’s right side, the patient’s right will be toward the left side of the screen, and the patient’s left will be toward the right side of the screen.

The orientation of the parasternal long axis view aligns with the axis of the heart rather than the external body. The probe marker is pointed toward the patient’s right shoulder.

Transducer markerImage 9: Transducer marker

 

Longitudinal OrientationImage 10: Longitudinal Orientation

 

Pelvic Transverse ViewImage 11: Transverse Orientation

 

Procedure Steps

Perform the eFAST exam immediately after the primary ATLS survey. Some authorities recommend applying e-FAST during the circulation phase of the primary survey, especially in hemodynamically unstable patients. It should be performed before the patient is rolled to minimize shifts independent fluid collections.

Imaging of the Heart for Pericardial Effusion and Tamponade

The first image obtained should be the heart. To obtain a view of the pericardial space, use either a subcostal or a parasternal long axis view. A low-frequency phased array or curvilinear probe should be used.

Subcostal Transducer PositionImage 12: Subcostal Transducer Position. To obtain this view, use the liver as the acoustic window.

 

Normal Subcostal viewImage 13: Normal Subcostal View. The right ventricle is the closest cardiac chamber to the chest wall. The left ventricle and both atria are also visible. The bright white line is the pericardium.

 

Video 1: Normal Subcostal Cardiac View. Again, the right ventricle is the closest cardiac chamber to the chest wall. The left ventricle and both atria are also visible. The bright white line is the pericardium. No anechoic fluid is visualized between the heart and the pericardium. There is a normal heart rate and good contractility.

 

Video 2: Large Pericardial EffusionIn this subcostal view, a pericardial effusion forms a black, anechoic rim around the heart.

 

Video 3: Pericardial Tamponade. The right ventricle, the closest chamber to the transducer, is collapsed, indicating that pressure from the pericardial fluid is inhibiting ventricular filling.

 

Video 4: Hypodynamic Heart. This patient has a hypodynamic heart with a low ejection fraction. To estimate ejection fraction, concentrate on the left ventricle. Decreased cardiac contraction may indicate that cardiogenic shock rather than hypovolemic shock is the cause of the patient’s hypotension. There is also a small pericardial effusion.

 

Video 5: Hyperdynamic Heart. The left ventricle has a high ejection fraction typical of someone with significant blood loss. The heart is attempting to circulate the remaining intravascular volume.

 

Parasternal Long Axis Transducer PositionImage 14: Parasternal Long Axis Transducer Position

 

Normal Parasternal Long Axis Cardiac ViewImage 15: Normal Parasternal Long Axis Cardiac ViewIf an adequate subcostal view of the heart cannot be obtained, attempt the parasternal long axis view. A subcostal view might be difficult in some trauma patients if they have an abdominal injury, epigastric tenderness or abdominal distention. In this view, the right ventricle is still the closest cardiac chamber to the anterior chest wall. The left ventricle left atrium, and aortic outflow tract are also visible.

 

Video 6: Normal Parasternal Long Axis View

 

Video 7: Pericardial Effusion. There is a large anechoic pericardial effusion

 

Video 8: Large Pericardial Effusion

 

Video 9: Hypodynamic HeartThis patient has congestive heart failure and a low ejection fraction. Look at the left ventricle to get a gross estimation of the heart’s ejection fraction. Obtain an overall gestalt to label the ejection fraction as “normal,” “high,” “decreased,” or “severely decreased.”

 

Video 10: Hyperdynamic Heart. This patient has a hyperdynamic heart with an ejection fraction close to 100%.

Imaging of the Abdomen for Free Intraperitoneal Fluid

Right Upper QuadrantImage 16: Right Upper Quadrant. Next, the abdomen is imaged for free fluid. The right upper quadrant is the abdominal view that is the most likely to be positive. The transducer is placed in the mid-axillary line with the probe marker pointed toward the patient’s head. A low-frequency, curvilinear or a phased array probe should be used to obtain this view.

 

Normal Right Upper Quadrant ViewImage 17: Normal Right Upper Quadrant View. First, identify the kidney and the liver. The kidney is often the easiest structure to identify. It has a bright white center surrounded by the less echogenic cortex. The hepatorenal space, the interface between the kidney and liver, is a potential space that may contain free fluid. In this image, the patient’s head is toward the left side of the screen, and the feet are toward the right side of the screen. The diaphragm is the bright white line just superior to the liver. It is important to visualize the tip of the liver as well as the inferior pole of the kidney to have an adequate assessment of the hepatorenal space.

 

Video 11: Normal Right Upper Quadrant. Again, the probe marker is pointed toward the patient’s head. This orientation corresponds to the probe marker indicator on the screen. There is no fluid collection between the kidney and the liver. As a patient breathes, the diaphragm lowers the position of the liver and kidney into a more inferior position.

 

Abnormal Right Upper QuadrantImage 18: Abnormal Right Upper Quadrant. Note the small anechoic fluid collections between the liver and the kidney.

 

Video 12: Abnormal Right Upper Quadrant. In this abnormal view of the right upper quadrant, there is a dark, anechoic stripe between the liver and the kidney. The liver is floating in a large amount of free fluid.

 

Video 13: Free Fluid. Free fluid typically has pointy edges. In contrast, fluid contained within a lumen has rounded edges. The image shows free “pointy” fluid between the liver and the kidney.

 

Video 14: Luminal Fluid. The anechoic structure in this image is the gallbladder. Bile is an anechoic liquid, but since it is contained within the lumen the gallbladder, the edges appear rounded.

There are several other free fluid mimics. Tese are;

  • Gallbladder
  • Perinephric fat
  • Stomach or duodenum
  • Inferior vena cava

Perinephric fat can be mistaken for echogenic clot. However, this fat is usually symmetric, so compare with the opposite side. Fluid within the lumen of the stomach or duodenum should also have rounded edges. Fluid within the IVC should not only be rounded, but should show vascular flow with color Doppler.

 

Left Upper QuadrantImage 19: Left Upper Quadrant. To obtain the left upper quadrant view, position the probe at the left posterior axillary line near ribs nine and ten. Again, the probe marker is pointed toward the patient’s head. Since rib shadows may obscure your view, it is sometimes helpful to angle the probe obliquely in line with the intercostal space. Many novice sonographers do not position the probe posteriorly enough. The sonographer’s hand should be parallel to and be resting on the bed. Since the spleen is smaller than the liver, the interface between the spleen and the kidney will be higher on the left side of the body. In awake, cooperative patients, asking the patient to take a deep breath may lower the spleen into the field of view.

 

Normal Left Upper QuadrantImage 20: Normal Left Upper Quadrant. This normal view of the left upper quadrant shows the spleen and the kidney. As with the right upper quadrant view, the patient’s head is to the left of the screen, and the patient’s feet are toward the right of the screen. The diaphragm is a bright white, hyperechoic curving line superior to the spleen. On the left side, examine the space between the kidney and the spleen for free fluid. However, it is more likely that fluid will accumulate around the dome of the spleen and, therefore, you must image the dome of the spleen.

 

Video 15: Normal Left Upper Quadrant. In this video of a normal left upper quadrant, there is no collection of free fluid either between the spleen and the kidney or between the spleen and the diaphragm. There appears to be tissue with the same echogenicity as the spleen superior to the diaphragm (the left of the screen). However, this is a mirror image artifact and, later in this chapter, we will discuss how the absence of this artifact can indicate fluid within the chest cavity.

 

Video 16: Abnormal Left Upper Quadrant. In this abnormal left upper quadrant view, there is fluid superior to the dome of the spleen. Imaging only the splenorenal interface would have missed this very abnormal finding. In the trauma patient with free intraperitoneal fluid, the spleen is the most commonly injured organ. However, the most likely location for fluid to accumulate is in the right upper quadrant. While this may seem counterintuitive, in a supine patient, the right upper quadrant is the most dependent area of the upper abdomen. So, in a patient with a positive intra-abdominal fast view, the location of the injury cannot be ascertained by the location of the fluid.

 

Pelvic Tranvers ViewImage 21: Pelvic View. The pelvic view is obtained by placing the transducer in a suprapubic position in either a transverse or longitudinal orientation. Since the bladder is the acoustic window, it is helpful to image the patient before the placement of a Foley catheter.

Here the transducer is in a transverse orientation with the probe marker pointed toward the patient’s right side. Angle the transducer so that its beam is pointed inferiorly in order to visualize the pelvic organs.

Video 17: Normal Pelvic View. This normal, transverse suprapubic view fans through the bladder. Look for free fluid lateral or inferior to the bladder.

Video 18: Normal Longitudinal Suprapubic View

Video 19: Abnormal Pelvic View. This video demonstrates free fluid adjacent to the bladder. The uterus is visualized floating within the fluid.

Video 20: Abnormal Pelvis View. Often the collection of free fluid is subtle as demonstrated by this retrovesicular collection.

Imaging of the Thorax for Hemothorax and Pneumothorax

To image the patient for the presence of a hemothorax, start with either the right or left upper quadrant view while angling the probe cephalad to image each hemithorax. The probe may need to be moved one rib space toward the patient’s head. Focus on the diaphragm and look for the mirror image artifact of the liver or the spleen on the cranial side of the diaphragm. If the mirror image is absent, there is fluid within the pleural space.

 

Hemothorax Tranducer PositionImage 22: Transducer Position. Make sure to angle the beam of the transducer into the chest cavity.

 

Normal HemithoraxImage 23: Normal Hemithorax. This image shows the kidney, liver, and diaphragm. However, as you transition to the chest cavity at the insertion of the diaphragm, air scatters the ultrasound beam, and you lose visualization of the spine. In addition, you can see a mirror image artifact.

 

Hemothorax or Pleural EffusionImage 24: Hemothorax or Pleural Effusion. In this image, there is a normal hepatorenal space. The diaphragm is visualized at its insertion. Rather than a mirror image, there is an anechoic fluid collection, and the thoracic vertebrae are visible. In addition, there is a “spine sign.” Usually, the spine cannot be visualized within the thoracic cavity because air scatters the ultrasound beam. If you are able to visualize the spine, then there is a medium present (free fluid) which can transmit the sound wave.

Video 21: Normal hemithorax. This video demonstrates a normal right upper quadrant and hemithorax with a mirror image artifact.

Video 22: Small Pleural Effusion or Hemothorax. In this video of the chest, there is an anechoic, pleural effusion rather than the mirror image. The spine is visualized in the chest cavity. The tip of the lung floats into the picture as the patient breaths.

Video 23: Free fluid within both the right thoracic and abdominal cavities. Fluid is visible both superior to and inferior to the diaphragm.

 

Transducer Position to Evaluate for PneumothoraxImage 25: Transducer Position to Evaluate for Pneumothorax. The extended FAST exam also images each hemithorax for pneumothorax.

Lung sliding rules out pneumothorax in the segment of lung the transducer is imaging.

Since air rises, the transducer should be placed at the most superior region of the chest. In the supine, trauma patient, this position is usually the third intercostal space. If the patient is sitting, the apices of the lungs should be imaged. A high-frequency probe should be placed in a longitudinal position with the indicator pointed toward the patient’s head.

 

Normal LungImage 26: Normal Lung. The patient’s head is to the right of the screen, and his feet are to the left. Look for a rib and a rib shadow as landmarks to help find the pleural line. The bright, white light line is the opposition of both the visceral and the parietal pleura and should shimmer, moving back and forth (a sliding motion) with respirations.

Video 24: Normal Lung. In this video of normal lung, identify the superior rib (left side of the screen) and the inferior rib (right side of the screen) with their corresponding rib shadows. The bright white line between the two is the plural line and can be seen sliding or shimmering.

 

PneumothoraxImage 27: Pneumothorax. The inferior rib and rib shadow are still visible, but only the visceral pleura is visualized. The parietal pleura covering the surface of the lung has dropped away from the chest wall. The two pleural layers no longer slide over each other.

Video 25: Pneumothorax. Recognize the inferior and superior ribs with their corresponding rib shadows and the bright light line is the parietal pleura. Note this line is not sliding with respirations.

Video 26: Pneumothorax. This video shows another example of a pneumothorax.

Absent lung sliding can be associated with pneumothorax; however, lack of lung sliding does not “rule in” a pneumothorax. Pneumothorax would be the most likely diagnosis; however, there are several conditions you should consider. Lack of sliding may be observed in patient who are not breathing, who have a mainstem intubation, or in cases where the pleura is adherent to the chest wall.

Vena Cava Imaging for Volume Assessment

The inferior vena cava (IVC) normally has respiratory variation. In a patient with normal volume status, the IVC will collapse 30-70 percent as the patient inhales. The IVC caliber of hypovolemic patients will be smaller and collapse greater than 70%. Conversely, patients with fluid overload will have an enlarged IVC with minimal collapse.

 

Transducer Position for Volume AssessmentImage 28: Transducer Position for Volume Assessment. Place the transducer on the abdomen with the probe marker pointed towards the patient’s head. Visualize the vena cava about 3 cm proximal to the cavoatrial junction.

Video 27: Euvolemia. This video demonstrates a normal inferior vena cava in a patient who is euvolemic. There is respiratory variation in the vena cava, but the collapse is not greater than 30%.

Video 28: Hypovolemia. The walls of the vena cava completely collapse with respiration in this hypovolemic patient.

IVC collapse estimates the patient’s volume status. It does not predict the patient’s response to hydration.

Video 29: Volume Overload. There is a large vena cava with minimal change with respiration.

Hints and Pitfalls

  • If initial eFAST exam is negative, but you have continued concern, repeat the exam.
  • Repeat the eFAST exam if there is a change in the clinical status.
  • Perinephric fat may be mistaken for clot; however, it is usually symmetrical. Examine the opposite side and compare.
  • Placing the patient in reverse Trendelenburg may help visualize free fluid.
  • Always remember that free fluid may not be blood – consider ascites, bladder rupture, and bowel rupture as causes of free intraperitoneal fluid.
  • Since the bladder is your acoustic window, the pelvic view should be imaged prior to insertion of catheter.
  • A normal echo does not definitively rule out major pericardial injury.
  • An epicardial fat pad may easily be misinterpreted as “clot.”
  • Hemothorax may be confused with pericardial effusion.

Post Procedure Care and Recommendations

Post-procedure care consists of clear communication of the results to the trauma team (positive, negative, or indeterminate for abdomen, thorax, and pericardium). Limited views should be discussed and scanning repeated by the most experienced sonographer. Adjunctive maneuvers to improve visualization such as repositioning the patient, or filling the bladder via foley catheter to obtain a better view of the pelvis should be considered. Clean ultrasound gel off the patient to help maintain body temperature. Clean and decontaminate the ultrasound machine based on your institutionally approved process by removing surface gel and using an appropriate surface wipe or process. Complete any additional documentation of the images along with a note describing the procedure and findings for inclusion into the medical record.

Cautionary Note

Complications of the eFAST are typically a result of incorrect performance or interpretation of results leading to false positive or false negative results. Difficult or limited exams should be discussed or repeated by the most experienced sonographer on the resuscitation team. Team leadership should also interrupt or delay the eFAST for critical interventions in the care of the patient. And, please keep in your mind, e-FAST should not delay the definitive treatment of trauma patient.

Pediatric, Geriatric and Pregnant Patient Considerations

In pediatric patient, the eFAST is highly specific but has insufficient sensitivity to exclude intra-abdominal injury. Though no change in test performance characteristics have been reported related to probe choice, consider using a higher frequency probe in smaller patients.

Pregnant patients present several challenges in clinical assessment and use of the eFAST exam. Clinical instability may require placing the patient in the lateral position to maximize blood flow to the uterus and require repositioning to complete the exam. Uterine enlargement can limit the view of the bladder but also result in displacement of bowel loops making pelvic views variable and occasionally dependent on fetal positioning. Late gestation is accompanied by other changes in addition to uterine enlargement including diaphragmatic elevation that may require repositioning the probe to achieve adequate views. Test performance has been reported to mirror those in non-pregnant patients in spite of these challenges. Another important requirement is rapid fetal assessment in trauma presentations. Rapidly determining the fetal heart rate should be determined on arrival and will likely precede initiation of continuous fetal monitoring by the obstetric team. Fetal reassessment should be regularly performed until continuous monitoring is available. Remember that ultrasound cannot exclude placental abruption – even in seemingly low force scenarios. Obstetric consultation and prolonged fetal monitoring is advised in all trauma cases involving a fetus of potentially viable gestational age.

References and Further Reading

  • Patel, Nirav Y., and Jody M. Riherd. “Focused assessment with sonography for trauma: methods, accuracy, and indications.” Surgical Clinics of North America. 2011; 91(1): 195-207.
  • Kirkpatrick, Andrew W. “Clinician-performed focused sonography for the resuscitation of trauma.” Critical care medicine. 2007; 35(5): S162-S172.
  • Moylan, Mark, Craig D. Newgard, O. John Ma, Alfredo Sabbaj, Tracy Rogers, and Rachelle Douglass. “Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients.” The Journal of emergency medicine. 2007; 33(3): 265-271.
  • Porter, Robert S., Brian A. Nester, William C. Dalcey, Michelle O’Mara, Tara Gleeson, Rebecca Pennell, and Frederick C. Beyer. “Use of ultrasound to determine need for laparotomy in trauma patients.” Annals of emergency medicine. 1997; 29(3): 323-330.

Links To More Information

  • Tsui, Chi Leung, Hin Tat Fung, Kin Lai Chung, and Chak Wah Kam. “Focused abdominal sonography for trauma in the emergency department for blunt abdominal trauma.” International journal of emergency medicine. 2008; 1(3): 183-187. – Link
  • Lee, Brett C., Eleanor L. Ormsby, John P. McGahan, Giselle M. Melendres, and John R. Richards. “The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy.” American journal of roentgenology. 2007; 188(2): 415-421. – Link
  • Melniker, Lawrence A., Evan Leibner, Mark G. McKenney, Peter Lopez, William M. Briggs, and Carol A. Mancuso. “Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial.” Annals of emergency medicine. 2006; 48(3): 227-235. – Link
  • Volpicelli, Giovanni, Mahmoud Elbarbary, Michael Blaivas, Daniel A. Lichtenstein, Gebhard Mathis, Andrew W. Kirkpatrick, Lawrence Melniker et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive care medicine. 2012; 38(4): 577-591. – Link
  • Gentry Wilkerson, R., and Michael B. Stone. “Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.” Academic Emergency Medicine. 2010; 17(1): 11-17. – Link
  • Ball, Chad G., Andrew W. Kirkpatrick, and David V. Feliciano. “The occult pneumothorax: what have we learned?.” Canadian Journal of Surgery. 2009; 52(5): E173. – Link
  • Soldati, Gino, Americo Testa, Sara Sher, Giulia Pignataro, Monica La Sala, and Nicolò Gentiloni Silveri. “Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department.” CHEST Journal. 2008; 133(1): 204-211. – Link
  • Blaivas, Michael, Matthew Lyon, and Sandeep Duggal. “A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax.” Academic Emergency Medicine; 2005; 12(9): 844-849. – Link
  • Chan, Stewart Siu Wa. “Emergency bedside ultrasound to detect pneumothorax.” Academic emergency medicine. 2003; 10(1): 91-94. – Link
  • De Lorenzo, Robert A., Michael J. Morris, Justin B. Williams, Timothy F. Haley, Timothy M. Straight, Victoria L. Holbrook-Emmons, and Juanita S. Medina. “Does a simple bedside sonographic measurement of the inferior vena cava correlate to central venous pressure?.” The Journal of Emergency Medicine. 2012; 42(4): 429-436. – Link
  • Weekes, Anthony J., Heather M. Tassone, Alan Babcock, Dale P. Quirke, H. James Norton, Krishnaraj Jayarama, and Vivek S. Tayal. “Comparison of serial qualitative and quantitative assessments of caval index and left ventricular systolic function during early fluid resuscitation of hypotensive emergency department patients.” Academic Emergency Medicine. 2011; 18(9): 912-921. – Link
  • Rozycki, Grace S., Robert B. Ballard, David V. Feliciano, Judith A. Schmidt, and Scott D. Pennington. “Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients.” Annals of surgery. 1998; 228(4): 557. – Link

Blogs & Websites

  • Robert Reardon: eFAST – Link
  • Mount Sinai Emergency Medicine Ultrasound: FAST – Link
  • Mount Sinai Emergency Medicine Ultrasound: Pneumothorax – Link
  • Mount Sinai Emergency Medicine Ultrasound: Thorax – Link
  • Katja Goldflam, Turan Saul, and Resa Lewiss: Focus On: Inferior Vena Cava Ultrasound – Link

Slide Sets

  • Petra Duran-Gehring: Ultrasound in Trauma – Link
  • Fahad Khan: Emergency Ultrasound in Trauma – Link
  • Alexis P Langsfeld: Sonographic Assessment of the Inferior Vena Cava – Link

Podcasts

  • B.M. Terry: FAST as Predictor of Clinical Outcome in Blunt Abdominal Trauma – Link
  • Haney Mallemat: Bedside Thoracic Ultrasound – Link
  • Mike Stone, Matt Dawson and Mike Mallin: Lung Ultrasound Part 1 – Link
  • Mike Stone, Matt Dawson and Mike Mallin: Lung Ultrasound Part 2 – Link
  • Christian Laursen, Vicki Noble, Andrew Liteplo, Matt Dawson and Mike Mallin: Lung US Journal Club Part 1 – Link
  • Justin Bowra SMACC: The Dark Art of IVC Ultrasound – Link
  • Matt Dawson and Mike Mallin: Fluid Responsiveness Part 1 – Link
  • Matt Dawson and Mike Mallin: Fluid Responsiveness Part 2 – Link

Videos

  • Beth Cadigan: The E-FAST Exam – Link
  • Geoff Hayden: eFAST – Link
  • Phillip Perera: Trauma FAST: Right Upper Quadrant – Link
  • Phillip Perera: Trauma FAST: Left Upper Quadrant – Link
  • Phillip Perera: Trauma FAST: Suprapubic View – Link
  • Phillip Perera: Cardiac Subxiphoid and Apical Views – Link
  • Phillip Perera: Cardiac Parasternal View – Link
  • Sara Damewood: Thoracic Ultrasound – Link
  • Phillip Perera: Pneumothorax – Link
  • Phillip Perera: Effusion – Link
  • Jon Fischer: Inferior Vena Cava Ultrasound – Link
  • Geoff Hayden: Volume Assessment: – Link

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