limitations of e-fast
TRANSCRIPT
Limitations of E-FAST
Brian Burns @HawkmoonHEMS
Clinical exam unreliable
Better than CXR
Quick
No radiation
Beyond traditional arenas
Extended use- TCA, RUSH, contrast sonography, pelvic #, confirm tubes, ONSD.
System
Clear place and role
Pre-hospital
Technical challenges
‘Turn-on’ the system
1. training & QA
2. reliable relaying of critical findings to decision maker
3. decision-making- destination
4. joined up M+M
Hospital
Clear institutional algorithms
Failure to correlate with clinical findings
Failure to act
Resus Bay
Exposure
Access interference- work flow
E-FAST timing
Close loop
PATIENT
combative/agitated
probe aversion
anatomy-obesity, subQ air, small females/kids
pre-existing pathologies
HIGH POWER: precordial penetrating + hypotensive blunt torso
LOWER POWER: penetrating projectiles trajectory
FALSE +Spec 95%
Enlarged GB/renal cysts (Morrison’s)
Fluid filled bowel
Perinephric fat in obesity
Pelvic-ovarian cysts, sem. vesicles, prostate
Lung- Bullae, adhesions, contusions
@sonospot
@sonospot
FALSE -
Sens 85%
<400ml FF in RUQ, <150ml in pelvis
Too early…..
Loculated PTx
Diagnosis
Limited to specific YES/NO Qs.
NOT good- solid organ injury, intestine,mesentery, diaphragm, retroperitoneal haem.
not delineate FF from Bladder rupture v bleeding
“A fool with a stethoscope will be a fool with an ultrasound”.
OPERATOR
Competency
Image acquisition
Image Interpretation
Image Correlation
Credentialing
NOT doing=MAJOR limitation
Steep learning curve interpretation
Competency: 25-50?
STORMRecognition E-FAST and BELS
Complete VLE and study manual
Complete workshop
Pass quiz
Minimum scan requirements + reviewed
Complete final competency exam
TECH
physics and ‘knobology’ knowledge
embed in credentialing
device advancement
