E-FAST curriculum

US Didactics/scan shifts:

Week 1 – RUQ, LUQ views –

Week 2- SX and PSL views –

Week 3 – Suprapubic view and incidental findings –

Week 4 – Lung Views –

Week 5 – Case-based presentations by Faculty, and Fellows present and review EFAST studies –

Reading/Review list:

SonoGuide: FAST

SonoSpot: Tutorial,  Cases,  Studies,  Tips & Tricks
Podcasts: Soundbytes:  Trauma/FAST and PulmonaryEMCrit with SonoSpot, and Ultrasound Podcast with Cliff Reid on E-FAST and Advanced Trauma Ultrasound

ACEP Trauma Ultrasound eBook

AIUM  – Practice Guidelines for FAST scan

AIUM Sound Judgement Series: Noble VE  Think ultrasound when evaluating for pneumothorax.



Ma/Mateer/Blaivas Chapter:

5. Trauma, O. John Ma, James R. Mateer, and Andrew W. Kirkpatrick


Dawson/Mallin iBook Chapters:

Volume 1, Chapter 1, EFAST/FAST

FAST Studies: Pubmed Collection

Pneumothorax studies: Pubmed Collection


FAST Studies:

Rozycki GS, Ochsner MG, et al. Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma1993; 34(4):516-527.

Jehle D, Guarino J, Karamanoukian H.Emergency department ultrasound in the evaluation of blunt abdominal trauma. Am J Emerg Med. 1993 Jul;11(4):342-6

Branney SW, Wolfe RE, Moore EE, Albert NP, Heinig M, Mestek M, Eule J Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. J Trauma. 1995 Aug;39(2):375-80

Ma OJ, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C  Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma. 1995 Jun;38(6):879-85

Henderson SO, Sung J, Mandavia D  Serial abdominal ultrasound in the setting of trauma. J Emerg Med. 2000 Jan;18(1):79-81

Ma OJ, Gaddis G, Steele MT, Cowan D, Kaltenbronn K Prospective analysis of the effect of physician experience with the FAST examination in reducing the use of CT scans. Emerg Med Australas. 2005 Feb;17(1):24-30

 Moylan M, Newgard CD, Ma OJ, Sabbaj A, Rogers T, Douglass R Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients. J Emerg Med. 2007 Oct;33(3):265-71. Epub 2007 Jul 5

Wherret LJ, Boulanger BR, McLellan BA et al ‘Hypotension after blunt abdominal trauma: the role of emergent abdominal sonography in surgical triage.’ J Trauma 1996;41:815-820

McKenny MG, Martin L, Lentz K et al ‘1000 consecutive ultrasounds for blunt abdominal trauma.’ J Trauma 1996;40:607-612

Scalea TM, Rodriguez A, Chiu WC et al ‘FAST Consensus Conference Committee. Focused Assessment with Sonography for Trauma (FAST): Results from an International Consensus Conference.’ J Trauma 1999;46:466-472

Coley BD, Mutabagani KH, Martin LC et al ‘Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma.’ J Trauma 2000;48:902-906

Nishijima DK, Simel DL, Wisner DH, Holmes JF. Does this adult patient have a blunt intra-abdominal injury? JAMA. 2012 Apr 11;307(14):1517-27. doi: 10.1001/jama.2012.422

Cardamore R, Nemeth J, Meyers C. Bedside emergency department ultrasonography availability and use for blunt abdominal trauma in Canadian pediatric centres. CJEM. 2012 Jan;14(1):14-9.

Kendall JL, Kestler AM, Whitaker KT, Adkisson MM, Haukoos JS. Blunt abdominal trauma patients are at very low risk for intra-abdominal injury after emergencydepartment observation. West J Emerg Med. 2011 Nov;12(4):496-504. doi: 10.5811/westjem.2010.11.2016

Diercks DB, Mehrotra A, Nazarian DJ, Promes SB, Decker WW, Fesmire FM; American College ofEmergency Physicians  Clinical policy: critical issues in the evaluation of adult patients presenting to the emergencydepartment with acute blunt abdominal trauma. Ann Emerg Med. 2011 Apr;57(4):387-404. doi: 10.1016/j.annemergmed.2011.01.013

Valentino M, De Luca C, Galloni SS, Branchini M, Modolon C, Pavlica P, Barozzi L. Contrast-enhanced US evaluation in patients with blunt abdominal trauma(). J Ultrasound. 2010 Mar;13(1):22-7. doi: 10.1016/j.jus.2010.06.002. Epub 2010 Jul 8

Kendall JL, Faragher J, Hewitt GJ, Burcham G, Haukoos JS. Emergency Department Ultrasound Is not a Sensitive Detector of Solid Organ Injury. West J Emerg Med. 2009 Feb;10(1):1-5

Friese RS, Malekzadeh S, Shafi S, Gentilello LM, Starr A  Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture. J Trauma. 2007 Jul;63(1):97-102

Rose JS, Richards JR, Battistella F, Bair AE, McGahan JP, Kuppermann N  The fast is positive, now what? Derivation of a clinical decision rule to determine the need for therapeutic laparotomy in adults with blunt torso trauma and a positive trauma ultrasound. J Emerg Med. 2005 Jul;29(1):15-21

Holmes JF, Brant WE, Bond WF, Sokolove PE, Kuppermann N Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Surg. 2001 Jul;36(7):968-73

Fox JC, Boysen M, Gharahbaghian L, Cusick S, Ahmed SS, Anderson CL, Lekawa M, Langdorf MI  Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011 May;18(5):477-82. doi: 10.1111/j.1553-2712.2011.01071.x.

Sola JE, Cheung MC, Yang R, Koslow S, Lanuti E, Seaver C, Neville HL, Schulman CI.

Pediatric FAST and elevated liver transaminases: An effective screening tool in blunt abdominal trauma. J Surg Res. 2009 Nov;157(1):103-7. doi: 10.1016/j.jss.2009.03.058. Epub 2009 May 3

Plummer D, Brunnette D, Asinger R, et al. Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann Emerg Med 1992 Jun;21(6):709-712.

Sierzenski PR, Schofer JM, Bauman MJ, Nomura JT. The double-line sign: a false positive finding on the Focused Assessment with Sonography for Trauma (FAST) examination. J Emerg Med. 2011 Feb;40(2):188-9. doi: 10.1016/j.jemermed.2009.07.029. Epub 2009 Oct 2

Nagdev A, Racht J The “gastric fluid” sign: an unrecognized false-positive finding during focused assessment for trauma examinations. Am J Emerg Med. 2008 Jun;26(5):630.e5-7. doi: 10.1016/j.ajem.2007.09.013


Pulmonary Studies:

Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995 Nov;108(5):1345-8

Lichtenstein D, Mezière G, Biderman P, Gepner A. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med. 1999 Apr;25(4):383-8

Lichtenstein D, Mezière G, Biderman P, Gepner A The “lung point”: an ultrasound sign specific to pneumothorax.Intensive Care Med. 2000 Oct;26(10):1434-40

Lichtenstein DA, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005 Jun;33(6):1231-8

Agricola E, Arbelot C, Blaivas M, Bouhemad B, Copetti R, Dean A, Dulchavsky S, Elbarbary M, Gargani L, Hoppmann R, Kirkpatrick AW, Lichtenstein D, Liteplo A, Mathis G, Melniker L, Neri L, Noble VE, Petrovic T, Reissig A, Rouby JJ, Seibel A, Soldati G, Storti E, Tsung JW, Via G, Volpicelli G.Ultrasound performs better than radiographs. Thorax. 2011 Sep;66(9):828-9; author reply 829. doi: 10.1136/thx.2010.153239. Epub 2010 Dec 30. No abstract available

Kirkpatrick AW, Ng AKT, Dulchavsky SA, ‘Sonographic diagnosis of a pneumothorax in apparent on plain radiography: confirmation by computed tomography.’ J Trauma 2001;50:701-702

Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, Hamiilton DR, Nicolaou S. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma. 2004 Aug;57(2):288-95.

Dulchavsky SA, Schwarz KL, Kirkpatrick AW, ‘Prospective evaluation of thoracic ultrasound in the detection of pneuomothorax.’ J Trauma 2001;50:201-205

Blaivas M, Lyon M, et al.  A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax.  Acad Emer Med2005; 12(9):844-849

Brook OR, Beck-Razi N, et al.  Sonographic detection of pneumothorax by radiology residents as part of the extended focused assessment with sonography for trauma.  J Ultrasound Med2009; 28(6):749-755

Wilkerson RG, Stone MB.  Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.  Acad Emer Med 2010; 17(1):11-17

Khaled Alrajhi, MD; Michael Y. Woo, MD; Christian Vaillancourt, MD, Test Characteristics of Ultrasonography for the Detection of Pneumothorax: A Systematic Review and Meta-analysis; CHEST 2012;141(3):703-708. doi:10.1378/chest.11-0131

Ku BS, Fields JM, Carr B, Everett WW, Gracias VH, Dean AJ. Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax. West J Emerg Med. 2013 Mar;14(2):103-8. doi: 10.5811/westjem.2012.12.12663

 Chan SS, Graham CA, Rainer TH  The value of chest ultrasonography in diagnosing pneumothorax in patients with trauma. Chest. 2012 Apr;141(4):1127-8; author reply 1128. doi: 10.1378/chest.11-3003. No abstract available

 Donmez H, Tokmak TT, Yildirim A, Buyukoglan H, Ozturk M, Yaşar Ayaz U, Mavili E  Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma? J Clin Ultrasound. 2012 Mar-Apr;40(3):142-6. doi: 10.1002/jcu.21884. Epub 2012 Feb 4

Sikora K, Perera P, Mailhot T, Mandavia D. Ultrasound for the Detection of Pleural Effusions and Guidance of the Thoracentesis Procedure. International Scholarly Network- ISRN Emergency Medicine. 2012; Article 676524.

International Liaison Committee on Lung Ultrasound (ILC-LUS) for the International Consensus Conference on Lung Ultrasound (ICC-LUS), Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012 Mar. 6;38(4):577–91.

Knudston JL, Dort JM, Helmer SD, et al. Surgeon-performed ultrasound for pneumothorax in the trauma suite. J Trauma 2004 Mar;56(3):527-530.

Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax.  Ann Emerg Med March 1997;29:312-316.

Volpicelli et al. Unusual New Signs of Pneumothorax. Critical Ultrasound Journal. 2013 Dec 19; 5 (1).


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