eFAST - extended Focused Assessment with Sonography for Trauma
The eFAST (extended FAST) is a rapid bedside point‑of‑care ultrasound (PoCUS) protocol used in the initial assessment of trauma patients. It extends the traditional FAST exam (RUQ, LUQ, pelvis, pericardium) by adding targeted thoracic views to detect pneumothorax and pleural fluid (haemothorax).
eFAST is a core PoCUS application in emergency medicine training and is intended to provide time‑critical, actionable information that may change immediate management.
Purpose and scope
- Rapid detection of free intraperitoneal fluid (presumed haemoperitoneum in trauma), pericardial effusion/tamponade, and evidence of pneumothorax or pleural fluid.
- Inform immediate management in unstable or deteriorating trauma patients (for example, triage to theatre vs CT).
- Not a substitute for CT when detailed parenchymal injury assessment or retroperitoneal evaluation is required; use CT in stable patients or when eFAST is non‑diagnostic (see NICE NG39, RCEM guidance).
Indications - when to perform eFAST
- Primary survey of trauma patients when rapid imaging may change management, especially:
- Haemodynamically unstable patients with suspected intra‑abdominal or intrathoracic injury.
- Peri‑resuscitation for suspected tamponade, tension pneumothorax or massive haemothorax.
- Triage in multi‑injury patients (a positive eFAST in an unstable patient may support immediate operative management rather than CT).
- In stable patients, use selectively as a rapid screen; a negative eFAST does not exclude significant injury and should not delay definitive imaging...