The objective of the FAST and eFAST is to detect free fluid in the trauma setting
In FAST the objective is to detect intraperitoneal and pericardial free fluid
In the eFAST evaluation of free fluid (pleura effusion) and free air (pneumothorax) in the pleural cavity is included as well
The FAST exam is covered in this e-course
The intrapleural component of the eFAST is covered in detail in the lung ultrasound e-learning course
The FAST examination is simple and effective, it can be repeated as required, and does not involve ionising radiation
The sensitivity and specificity of the FAST examination increases proportionally to the extent of bleeding
FAST and eFAST are used in trauma settings to identify free fluid in blunt or penetrating trauma
Furthermore, the same projections can identify free fluid (ascites, blood etc) in the peritoneum in non-trauma settings
Patients with cardiac arrest – 2D echocardiography
The characteristics are:
– Immobile myocardium
– Fibrillation
Possibly reversible causes for the cardiac arrest, which can be recognized with ultrasound are:
– Pericardial effusion
– Hypovolemia
– Pleural effusion
– Dilated right side (pulmonary embolus signs)
– Dilated left side
Always be aware that FATE is a supplement to the clinical evaluation
FATE does not substitute a full diagnostic cardiologic echocardiographic examination
In these two lessons you have completed approximately 40% of a full basic FATE course
We have focused on the most important part of point-of-care cardiac ultrasound, which is 2-dimensional imaging of the most important and easiest cardiac views. In addition you have learned how to do the very important pleura scan
The patients will appreciate to be more effectively examined and treated without bias and unnecessary time delay
This is the idea of the FATE protocol
You have the basic knowledge to do this although there is much more to learn on future courses: M-mode, more pathology, cardiac systolic and diastolic function, Doppler, pressure estimation and assessment of cardiac output as the most important
You have now learned about relevant pathology which can by recognised by the FATE examination
You should be able to recognise the following conditions:
The 2D echocardiographic characteristics of pulmonary edema
Look for:
– B-lines
B-lines are white laser-like beams that have their origin from the pleural line and continue to the far end of the image
B-line characteristics:
– One to three is normal at the basic parts of the lungs (position 4)
– B-lines are not normal at the anterior part of thorax
– With increasing amount of lung water the number and density of the B-lines will increase
– The presence of B-lines excludes pneumothorax at the scanning point (pneumothorax can be present in other parts of the thorax)
The presence of lung sliding excludes pneumothorax
The absence of lung sliding is NOT equal to the presence of pneumothorax
Notice, lung- or pleural sliding is only possible if the two pleural blades are in contact with each other
Detailed evaluation of pneumothorax should be performed with a linear or microconvex transducer
The presence of lung- or pleural sliding excludes pneumothorax at the scanning point
The presence of just one B-line excludes pneumothorax at the scanning point
If just one of the findings is present, pneumothorax can be excluded
The presence of lung or pleural sliding during positive pressure ventilation on both sides ensures correct placement of the endotrachial tube
The evaluation can take place anywhere on the thorax wall
Lung or pleural sliding in position 4
Notice: B-lines are present in D (normal finding in position 4 even in healthy people)
Multiple B-lines in a patient with pulmonary edema
Notice, B-lines start from the pleural line and extends to the the far end of the screen = 30 centimeter in depth
