This is the first of a three part series reviewing the eFAST scan in detail. The goal of this series is to aid new ultrasound users to perform their first eFAST scan correctly and improve existing sonographer’s understanding of the eFAST.
The Case
There are just too many eFAST cases to choose from. Which one to tell you…? Should I talk about my first eFAST patient, the supposed-to-be-simple-but-really-wasn’t, coumadin guy who laid out his motorcycle? What about the lady from the rollover down a twenty foot embankment? Or the teenager from a horseback riding accident? Should I tell you about the night I hung out in resuscitation and did an eFAST on every patient that came through? A December night in medical school I like to think of as Ultrasound Christmas. A night when a trauma alert rolled in and before I knew what was happening, the resident put the ultrasound probe in my hand and said “Go for it!” Needless to say it was AWESOME! Like do-a-secret-happy-dance-in-the-hallway-afterwards kind of awesome. I definitely loved my ultrasound elective, especially once I became competent at eFASTs. So what’s an eFAST you ask? It’s simple really. It’s a systematic ultrasound scan to check for pneumothorax and free fluid (usually blood) in the abdomen and chest. It’s quick, easy, and incredibly useful. You don’t have to be a genius for this stuff. My first year med students can do this and so can you! If you’re going to spend time in the Emergency Department or with critically ill patients, you should learn the eFAST. End of story. So now that you’re convinced… just how do you do an eFAST?
SonoQuizzes are a quick and easy way to test your ultrasound knowledge! They’re just for fun, but are a great way to see where you stand and what areas you can improve on. Plus, they go great with the FOAMed Curriculum modules to assess your learning. So give a quiz a try and see how you do!
Generally, I like to write about positive ultrasound cases. This is not one of those cases. But out of this sad case there was much learning to be had for this med student. At the time of the case, I was on an emergency ultrasound elective. And I couldn’t have be happier! I was learning all sorts of awesome and useful skills. Another perk of being on ultrasound duty was that I got to tag along on all the ultrasound cases I can get my hands on, including the traumas (a big perk in my book). As soon as I heard a trauma called in, I gowned up, gloved up, goggled up, and masked up. I observed the FAST exam (Focused Abdominal Scan for Trauma) and helped however I was instructed. Mostly squeezing IV bags or fetching things, but I was in there; I had a job; and I was learning ultrasound awesomeness. Life was good…. like really, really good. Until it wasn’t. Enter a teenager in an ATV accident. One paramedic cranks out compressions, while the other relays patient information. Car versus ATV. Trouble intubating. And he’s asystolic. Huge bummer. This is not going to be fun and someone somewhere is going to be very sad tonight. Everyone is hustling. I stand at the foot of the bed squeezing fluids into the kid while lines are placed, drugs are pushed, and they figure out what’s wrong. I watch the FAST exam. Looks negative to me, so no visible blood in the pelvis, abdomen, or around the heart. Unfortunately the ultrasound’s heart view also shows no heart movement. There is no electrical activity on the ECG. He’s been down for a long time. Time of death is called. Everyone puts down what they were doing and steps away. I feel heavy. After the room has cleared, the ultrasound attending pulls the ultrasound up to the bedside. There is a valuable teaching opportunity here. He does another FAST exam, explaining it as he goes. Still no free fluid in the pelvis, abdomen, or pericardium. He puts the probe on his chest. No signs of pneumo or hemothorax. This is weird; an ATV versus car with no major bleeding from the neck down. I’m supposed to be learning what an ultrasound exam looks like on a trauma patient, but so far it all looks pretty normal. That’s odd… so what killed this kid? The ultrasound attending agrees it’s unusual and wants to check one more thing. Here’s where things get interesting. The only visible trauma is from the neck up; some bleeding from the ears, eyes, and an open scalp lac. With no helmet that really isn’t a surprise. What is a surprise is the ultrasound attending putting the ultrasound probe on his eye. What are we suppose to tell from this..? Intracranial pressure. Mind blow. Now I’m pretty sure the ultrasound attending is a wizard. On the screen, we see a normal globe with a huge optic nerve and sheath exiting. Before he even measures it, he can tell it’s too big. He measures it and confirms ICP is elevated. So how’d he do this?
Measuring Intracranial Pressure Using Ocular Ultrasound
In a Nutshell
If you suspect elevated intracranial pressure (ICP), ocular ultrasound is a fast and easy method to detect it.
You can measure the optic nerve sheath diameter (ONSD) using ultrasound.ONSD > 5 mm may indicate an ICP > 20 mmHg, especially in symptomatic patients.
Not everyone with ONSD > 5 mm has elevated ICP.
ONSD > 5.7 mm indicates an ICP > 20 mmHg.
All patients with ONSD > 5.7 mm have elevated ICP.
Are you a medical student or physician trying to incorporate ultrasound in your clinical education? Is your clinical environment not so ultrasound friendly? SonoMojo’s got you covered. Check out our Vimeo post on “Learning Ultrasound in Ultrasound Naïve Environments“. It covers strategies for introducing ultrasound to the conversation, positively influencing patient care & hospital ultrasound culture, and creating your own ultrasound education in the absence of a formal ultrasound curriculum. Enjoy the post and happy ultrasounding!
SonoMojo is a guide to ultrasound education. It’s a place for the new-to-ultrasound to get started in bedside ultrasound education and for the ultrasound-pro to discover new ultrasound resources. We’ve collected the best of FOAMed ultrasound education in one place. We’ve also added a few of our own SonoMojo ultrasound resources to help you on your path to become an ultrasound master.
Be sure to check out these SonoMojo features:
Comprehensive Ultrasound Curriculum– our online FOAM-based ultrasound curriculum HERE
Orientation to Ultrasound Education Resources– an orientation to the best ultrasound education resources for getting started in bedside ultrasound HERE
Guide to Advancing Your Skills– a collection of suggested ultrasound education resources that will take your ultrasound skills to the next level once you’ve got the basics down HERE
Ultrasound Interest Group Toolbox– a how-to guide for creating medical student ultrasound education using an Ultrasound Interest Group HERE
SonoMojo is a guide to ultrasound education. It’s a place for the new-to-ultrasound to get started in bedside ultrasound education and for the ultrasound-pro to discover new ultrasound resources. We’ve collected the best of FOAMed ultrasound education in one place. We’ve also added a few of our own SonoMojo ultrasound resources to help you on your path to become an ultrasound master. You’ll also find resources to help you establish ultrasound education at your own institution.
Be sure to check out these SonoMojo features:
Comprehensive Ultrasound Curriculum– our online FOAM-based ultrasound curriculum.It’s broken down into individual modules on the menu toolbar for your convenience. Find it HERE.
Ultrasound Cheat Sheets- 1 page resource with the essential into you need to know about a scan. Use it to review before performing (or teaching) a scan or to help you prep before starting a new FOAMed module. Find them HERE.
SonoQuizzes– they’re a quick and easy way to test your ultrasound knowledge and find out what areas you can improve on. Find them HERE.
Essential Resources Section– an orientation to the best ultrasound education resources for getting started in bedside ultrasound. Find it HERE.
Beyond Basics Section– a collection of suggested ultrasound education resources that will take your ultrasound skills to the next level and go beyond basics. Find it HERE.
Ultrasound Interest Group Toolbox– a how-to guide for creating medical student ultrasound education using an Ultrasound Interest Group. Find it HERE.
US is fast, gives information in real time, improves quality and safety of patient care, and is cost effective
Better healthcare resources utilization
The AMA agrees: Resolution 802 states that using ultrasound is with all physicians’ scope of practice
Improve Your Education
Improves learning basic science concepts in anatomy and physiology (In one study ultrasound improved anatomy tests scores by 9%)
Improves physical exam skills (Get real time feedback on your physical exam findings)
Makes you look REALLY good on your clinical rotations
AAMC declared 2013 “The Year of Ultrasound” in an effort to promote ultrasound education in medical schools because they agree
Don’t Get Left Behind
Other students are learning this right now!
If you don’t have ultrasound or only have a little ultrasound in your curriculum:
Other schools have ultrasound fully integrated into their curriculums
You’ll be applying and going to residency with students who already learned ultrasound
If you already have a full 4 year curriculum:
This is an opportunity to develop your ultrasound skills even more and become an ultrasound master
Look Good and BE Good for Residency
Be better prepared and a more attractive applicant for residency
You’ll be prettier on paper during those pesky residency applications
You’ll be better prepared to use the ultrasound skills you’re expected to know
USIGs creates opportunities for leadership and career development
You’ll lead a student group, mentoring other students, develop your own projects (research, education, or otherwise)… all good stuff for the ol’ resume
You’ll get to know ultrasound faculty really well (who will write you nice letters of rec)
Finding time to learn ultrasound is much easier as a med student than as a resident
Learning ultrasound isn’t that hard
Plenty of evidence on this one too…
Others have created their own ultrasound education and started their own USIGs. You can do it too!
There’s plenty of resources out there (like this guide), so you’re not doing it on your own
Check out our Why Ultrasound Page for more info on why you should care about learning bedside ultrasound!
