Is the E more important than the FAST?
Working my usual shift at Janus General recently the Bat Phone rings to get us ready for pedestrians vs SUV. The Retrieval doctor lets us know they will be arriving in ten minutes time with the first patient but the second patient following straight after has bilateral haemopneumothoracies. It is the middle of the day and we managed to get the entire Trauma Service to our Resus area.
My patient (patient two) had two surgical registrars scrubbed and waiting on each side ready to put in chest drains on arrival.
Fortunately my trusty POCUS is smaller than the chest drain set and I weaseled in to complete the EFAST study as the patient was transferred from the ambulance trolley. No pleural fluid on the left or right; normal lung sliding bilaterally. I fought off the No. 11 scalpels wielded by the surgical registrars with my trusty curvilinear probe. I was scarred but my patient remained intact. Another chest saved from the Surgeons.
Fortunately both of my colleagues were wearing surgical masks so I didn’t have to look at their hangdog faces at missing another chest drain.
Thinking back to all my years of EFAST I wonder if the E has made a greater impact in my patient’s care than the FAST. I can recall many who have had chest drains placed or prevented based on my chest ultrasound yet none whose clinical care has been affected by my FAST.
As we start our new term how I can evaluate the affect of EFAST on our trauma patients here at Janus General? Maybe the easiest question is, how does the EFAST affect clinical management?
What is your experience with EFAST?
Is it a useful test or does it have no effect on your patients?
How can I monitor the EFAST effect?
Let us know with your comments below…