Why Use Ultrasound in Trauma?

E-FAST: Advantages

  • Rapid
  • Noninvasive
  • Bedside Procedure
  • May Repeat
  • Unstable Patients

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How to act on E-FAST Results:

E-FAST Protocol

E-FAST: Views

  • Cardiac
  • RUQ
  • LUQ
  • Pelvis
  • Pleura

E-FAST: Left Upper Quadrant (Splenorenal View)

  • Posterior Axillary Line “Knuckles on the Bed”
  • Probe Indicator to Head
  • 9th to 11th Interspace

E-FAST: Pelvis (Suprapubic View)

  • Able to detect 100 ml
  • Two views
  • Indicator to patients right (transverse view) sweep up and down
  • Indicator to patients head (sagittal view) Sweep side to side
  • Perform before Foley catheter

E-FAST: Pleura

  • Linear Transducer
  • Evaluate Pleura anteriorly and laterally
  • Place probe perpendicular to ribs (long axis view)

Extended FAST Clinical Findings:

E-FAST: Pericardium

Free Fluid in Morrison’s Pouch in Right Upper Quadrant

E-FAST: Right Upper Quadrant for Free Fluid

  • Free Fluid
  • Infradiaphragmatic Space
  • Morrison’s Pouch
  • Caudal Tip of Liver

Free Fluid in Left Upper Quadrant

E- FAST: Left Upper Quadrant

Free Fluid in Pelvis

E-FAST: Pelvis


E-FAST: Pneumothorax

How Important Is the “Golden Hour” After Trauma?

Joseph Esherick, M.D., FAAFP, FHM

March 14, 2015

Traditional dogma teaches that it is crucial for trauma patients to reach the hospital and be treated within 1 hour of injury (the “golden hour”). Investigators reviewed data from a large trauma registry to determine outcomes for two cohorts of patients: 778 with traumatic shock and 1239 with traumatic brain injury.

In the traumatic-shock cohort, 26% died within 28 days of injury (the primary endpoint). In the brain-injury cohort, 53% experienced a bad outcome, defined as a 6-month Glasgow Outcome Scale–Extended score of ≤4 (the primary endpoint). Out-of-hospital time longer than 1 hour versus shorter than 1 hour was not associated with worse outcomes. Among 484 traumatic-shock patients requiring early critical hospital resources, those arriving after 1 hour had higher 28-day mortality than those arriving within 1 hour (adjusted odds ratio, 2.4).


This study from a large trauma registry demonstrated that patients with traumatic brain injury (TBI) but no shock had similar outcomes whether they arrived within one hour or after one hour of injury.  However, patients who had traumatic shock had a lower 28-day mortality if they arrived within one hour versus arrival after one hour.

What is more critical for trauma patients who are NOT in shock is to get them to a Trauma Center as quickly as possible.


  1. Newgard CD et al. Revisiting the “golden hour”: An evaluation of out-of-hospital time in shock and traumatic brain injury. Ann Emerg Med 2015 Jan 14; [e-pub].