EFAST

EFAST stands for Extended Focused Assessment with Sonography for Trauma. It is a bedside ultrasound protocol used in the assessment of trauma patients to rapidly identify critical conditions. The exam builds on the traditional FAST (Focused Assessment with Sonography for Trauma) by adding thoracic views to evaluate the chest for injuries in addition to the abdomen and pelvis.

The eFAST protocol typically includes abdominal views that assess for free intraperitoneal fluid and pericardial effusion, as well as pelvic fluid when feasible. It also includes chest views to detect pneumothorax and pleural effusion or other thoracic injuries. Clinicians look for signs such as the absence of cardiac motion related to effusion, free fluid in Morison’s pouch or the splenorenal recess, and lack of lung sliding or other indicators of air in the pleural space.

Indications for eFAST include evaluation of trauma patients who are unstable or have concerning blunt or penetrating injuries. It is used in emergency departments, operating rooms, and prehospital settings to inform early management, including the need for surgical intervention or further imaging.

Advantages of eFAST include its speed, lack of ionizing radiation, repeatability, and ability to be performed at the bedside. Limitations include dependence on operator skill, potential difficulty in obese patients or those with subcutaneous emphysema, and the possibility of missing injuries that are not visible with ultrasound. Training and experience influence diagnostic accuracy, which can vary across settings.

History notes: eFAST evolved from the FAST protocol with the addition of thoracic views in the late 1990s to early 2000s and is widely taught in emergency medicine and trauma curricula.