E-FAST

Many factors influence the velocity of ultrasound waves transmitted through the
human body including tissue densities and tissue stiffness:

Density – the velocity of ultrasound waves traveling through tissue depends on the
density of the tissue

Reflection – reflection occurs at interfaces between tissues of different densities

Refraction – the bending of sound waves at tissue interfaces as the ultrasound

waves strike them obliquely

Scatter –reflection of ultrasound waves from tiny objects such as small areas of gas

Attenuation – the diminution, or weakening, of signal energy as it passes through a

medium

Transducers
Curvilinear – A larger curved “footprint” transducer (Figure 2) that is typically
used for abdominal, obstetrics and gynecology, and nerve imaging. Allows for
imaging of deeper structures at the expense of resolution.

Linear array transducers – used for vascular, musculoskeletal, nerve, ocular, and
small parts imaging. Allowing for higher resolution imaging of superficial
structures.

Phased array transducers – facilitate intercostal imaging of the heart. hey have a
small superficial field of view which can limit superficial imaging and transmit in
the frequency range of 1-5 MHz.

Endocavitary transducers (Figure 5) – are small footprint curved array transducers

that can be inserted into an orifice to obtain imaging closer to the structure of
interest. placed endovaginally to obtain gynecologic and obstetric images but are
also used to visualize peritonsillar abscesses.

Ultrasound Gel and Covers

Because ultrasound waves are poorly transmitted through air the gel provides a
medium with similar impedance to human tissue that the ultrasound waves can
easily pass through.
Ultrasound Modes
B-mode – two-dimensional diagnostic ultrasound image

M-mode – one dimensional diagnostic ultrasound image in y-axis over time in x-

axis (Figure 7)

Doppler – diagnostic ultrasound used to detect blood flow, displayed as speed and
direction of flow (Figure 8)

Color Doppler and Power Doppler – display of a Doppler signal in color and is
especially useful for small blood vessels and vessels with low-velocity flow
(Figure 9)

Trauma
used in the setting of trauma to evaluate for free fluid in the abdominal cavity due
to vascular or hollow viscus injury.

Intrauterine pregnancy
Emergency ultrasound can be used in the setting of pregnancy to evaluate for the
presence or absence of intrauterine pregnancy .
A finding of intrauterine pregnancy (Video 2) in most patients effectively rules out
ectopic or heterotopic pregnancy.

Abdominal Aortic Aneurysm

relatively common finding in patients over 50 years of age and can be evaluated
using bedside ultrasound. Dilation of the abdominal aorta greater than 3 cm
indicates an AAA and patients with dilation greater than 5 cm (Figure 11) are at
increased risk for spontaneous rupture of the aorta.

Aortic dissection can also be assessed with bedside ultrasound and the Finding of
an intimal flap (Video 4) is pathognomonic for this emergency disorder of the
aorta.

Cardiac
 transthoracic cardiac ultrasound is indicated in patients with significant
cardiovascular compromise

 It is used to assess overall cardiac function (Video 5) and rapidly identify
potentially reversible conditions such as pericardial effusion and tamponade. 

The standard cardiac views include the subxyphoid / subcostal, parasternal long
axis, parasternal short axis and apical four-chamber

Biliary
Biliary pathology including cholelithiasis (Figure 12) causing biliary colic and
cholecystitis is commonly found in patients presenting to the emergency
department.
The primary abnormalities noted in patients with biliary disease include the
presence of gallstones or gallbladder sludge, thickened gallbladder wall,
pericholecystic fluid, dilated common bile duct and sonographic Murphy’s sign.

Urinary Tract
The presence of hydronephrosis
Ureteral jets (Video 8) can also be assessed with bedside ultrasound and may
provide additional information as to the degree of ureteral obstruction.

Deep Vein Thrombosis

The ultrasound transducer is used to compress the venous system of the lower
extremity to assess the venous vessels for patency. A non-compressible venous
blood vessel indicates the presence of venous thrombus 

Soft Tissue/Musculoskeletal
utilized to evaluate the soft tissue for the presence of abscess or cellulitis in the soft
tissues. evaluation of ligamentous and tendinous structures such as Achilles tendon
rupture. Fractures can also be evaluated with ultrasound.

Ocular
evaluate for ocular injuries such as foreign body, lens dislocation, as well as
vitreous hemorrhage and retinal detachment.
used to evaluate patients with potential increased intracranial pressure by
evaluating the optic nerve shadow.

 A normal ultrasound FAST exam does not rule out traumatic intra-
abdominal injury.