EFAST

eFAST (extended focused assessment with sonography in trauma) is a rapid (a few minutes) ultrasound protocol used in the context of blunt or penetrating trauma which can be used to identify free fluid in the peritoneum, which is presumably blood, as well as pneumothorax, haemothorax, or pleural effusion. It involves examining a certain set of abdominal and thoracic regions for free fluid.

Order of examination:

• Hepatorenal region -> Pericardium -> Perisplenic -> Suprapubic -> Right and left chest

However, it should be kept in mind that a negative eFAST doesn’t rule out intraabdominal injury, as eFAST cannot discern diaphragmatic tears, pancreatic injury, bowel perforation, and small amounts of free fluid (<500 mL). The sensitivity of eFAST is also limited. The main objective of eFAST is to decrease the number of people who require a CT scan, thereby shortening their time to surgery.

In case eFAST detects intraabdominal free fluid, the patient has likely suffered large injuries which require surgery, and so the patient should be taken to emergency laparotomy.

In case eFAST does not detect any pathology, an abdominal CT scan should be performed if the risk for intra-abdominal injury isn’t low. If the abdominal CT shows injury, emergency laparotomy should be performed.