Pathologies identifiable on eFAST (Extended Focused Assessment with Sonography for Trauma)
Introduction
The eFAST exam is a focused, time‑critical bedside ultrasound protocol used during the primary survey of the injured patient to detect immediately life‑threatening conditions that change resuscitation or urgent surgical decisions.
Its main purpose is rapid detection of free intraperitoneal, pleural or pericardial fluid and sonographic signs of pneumothorax.
eFAST is an adjunct to clinical assessment: a positive eFAST in an unstable patient often mandates urgent intervention, but a negative eFAST does not reliably exclude significant injury and must not by itself delay or withhold further imaging or definitive care (NICE NG39; Resuscitation Council UK; RCEM).
General considerations
- Role: Answer focused questions that alter immediate management - for example, “Is there free intra‑abdominal or pleural fluid?”, “Is there pericardial fluid with tamponade physiology?”, and “Are there sonographic signs of pneumothorax?”
- Timing: Perform when it will not delay transfer or definitive care; use during the primary survey (A-E) for major trauma (NICE NG39).
- Operator competence and governance: Only trained clinicians should perform and interpret eFAST; local governance, image archiving and documented competency are required (RCEM curriculum; FEEL/Resuscitation Council guidance).
- Equipment and views: Use a curvilinear probe (3-5 MHz) for abdominal and pleural recesses and a high‑frequency linear probe for anterior chest/lung sliding. Standard views are RUQ (Morison’s pouch), LUQ...