E-FAST
Set-up
- Probe: Phased array/Curvilinear
- Mode: FAST
- Starting Depth: 10 cm
Views
- Morrison’s Pouch
- Retrovesicular Space
- Sagittal
- Transverse
- Perisplenic
- Subcostal Cardiac
- Lung sliding
Scanning
- MP (Liver and kidney junction):
- Indicator to patients head, placed on R midaxillary line at inferior rib margin
- Be sure to examine the caudal tip of the liver, as this is the area where fluid often accumulates first
- Assess above the diaphragm to determine if pleural effusion present
- PS (Between the spleen and the diaphragm):
- Place probe at L posterior axillary line with indicator toward patient’s head
- This view is often slightly more superior and posterior than MP
- Assess above the diaphragm to determine if pleural effusion present
- RV (Space above and slightly behind bladder):
- Saggital view: Place probe just above pubic symphysis with indicator toward patient’s head, and rock handle up to look down, then fan side to side
- Transverse view: Rotate indicator to patient’s R, then fan up and down
- Cardiac: SC view or PSL view (See cardiac section for technique)
- Lung Sliding:
- Best to assess with linear probe: Change to Thoracic settings, place probe at mid clavicular line with indicator toward patients head.
- Evaluate 2-3 intercostal spaces on most anterior chest for motion at plural line
Morison’s Pouch
Liver/Kidney interface![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/MP-labeled-300x215.png)
Perisplenic view
Spleen/Diaphragm interface![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/PS-labeled-300x244.png)
Retrovesicular Sagittal
Space above and behind bladder![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/RVsag2-300x237.png)
Retrovesicular Transverse
![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/RVtrans1-300x192.png)
Subcostal
![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/SCarrows-300x197.png)
Lung Sliding
Look for movement on the pleural line![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/normallung5-300x204.png)
Morison’s Pouch free fluid
Fluid located between the liver and kidney![](http://cmcpemfellowship.com/wp-content/uploads/2020/10/MPfluid-300x203.jpg)
Perisplenic free fluid
Fluid between the spleen and diaphragm![](http://cmcpemfellowship.com/wp-content/uploads/2020/10/posPS-300x230.jpg)
Retrovesicular free fluid (Transverse view)
![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/transfreefluid1-300x225.png)
Retrovesicular free fluid (Sagittal view)
![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/sagfreefluid-300x225.png)
Pericardial Effusion
![](http://cmcpemfellowship.com/wp-content/uploads/2021/01/percardial-effusion-sc-view-300x229.png)
Pneumothorax
No movement is seen on the pleura
Incomplete view of Morison’s pouch
Fix → Scan to view the caudal tip of liver and inferior pole of the kidney
Missed free fluid posterior to the bladderFix → Fluid behind the bladder may appear isoechoic due to posterior acoustic enhancement. Adjust time gain compensation to decrease this artifact
Difficulty obtaining perisplenic viewFix → Adjust probe to get a more posterior view of the LUQ
Free fluid incorrectly identified in thorax or abdomenFix → Identify the location of free fluid in relation to diaphragm. Fluid above the diaphragm is located in the thorax, while fluid below the diaphragm is located in the abdomen