Skill Station E

ADJUNCTS

LEARNING OBJECTIVES

1. Identify the appropriate positioning of an
ultrasound probe for FAST and eFAST exams.
2. Identify fluid on still images or video of FAST exam.
3. Identify ultrasound evidence of pneumothorax on
video images of an eFAST exam.
4. Use a structured approach to interpret a chest x-ray
and identify injuries present (see Skill Station
B: Breathing).
5. Explain the value of the anteroposterior (AP) pelvic
x-ray examination to identify the potential for
massive blood loss, and describe the maneuvers
that can be used to reduce pelvic volume and
control bleeding.
6. Use a structured approach to interpreting a plain
x-ray of the spine or CT (based on course director’s
preference).
7. Use a structured approach to evaluating a pelvic x-ray.

Sk ill s Inc luded in this

Sk ill S tation

•• Perform a FAST Exam and Properly

Position Probes
•• Perform an eFAST Exam and Properly
Position Probes
•• Identify Abnormal eFAST on Still or Video
Images
•• Identify Fluid on FAST Video or Still Images of
FAST
•• Evaluate Thoracic and Lumbar Spine Images
n FIGURE G-1 
•• Interpret a Pelvic X-Ray
the right (n FIGURE G-1). The probe angle
is shallow, and the liver is used as an
Per for m a FA ST E x a m and acoustic window.
Proper ly P osition Probe s STEP 2. Move to the right upper quadrant view.
Place the probe marker toward the head
STEP 1. Use a low-frequency probe (3.5 mHz). in the coronal plane in the anterior
Start with the heart to ensure the gain is axillary line (n FIGURE G-2). Rotate the
set appropriately. Fluid within the heart probe obliquely and scan from cephalad to
will appear black. Place the probe in the caudad to visualize the diaphragm, liver,
subxyoid space, with the probe marker to and kidney.

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­366 APPENDIX G n Skills
n FIGURE G-2  n FIGURE G-3
n FIGURE G-4  n FIGURE G-5
STEP 3. Scan the left upper quadrant. Position
the probe marker toward the head in the
coronal plane (n FIGURE G-3). Begin scan
more cephalad than on the right and more
posterior. Begin in the midaxillary line.
Rotate the probe obliquely and visualize
the diaphragm, spleen, and kidney.
STEP 4: (Ideally, the bladder is full.) Place the probe
above the pubic bone with the probe marker
pointing to the right (n FIGURE G-4). Scan
for fluid, which appears as a dark stripe.
Rotate the probe 90 degrees so the probe
marker points to the head (n FIGURE G-5). Scan
for fluid.
Per for m an eFA ST e x a m
and Demons trate Proper
Probe P ositioning
STEP 1. Place the probe in the second or third
intercostal space in the mid clavicular line in
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a sagittal orientation (n FIGURE G-6), and slide
the probe caudally (n FIGURE G-7). Examine 2
or 3 interspaces. Including more interspaces
increases the sensitivity
STEP 2. Evaluate the right and left diaphragms using
the same probe position as for evaluation
of the perihepatic and perisplenic space
(n FIGURE G-8), sliding the probe one rib space
cephalad (n FIGURE G-9).
Identif y A bnor m a l e FA ST
on S till or V ideo Im ag e s
STEP 1. Look for lung sliding. If you see none, look
for lung pulse.
STEP 2. Look for comet tails.
STEP 3. Look for seashore, bar code, or stratosphere
sign in M mode. Bar code and stratosphere
signs indicate pneumothorax.
­367 APPENDIX G n Skills

n FIGURE G-6  n FIGURE G-7 

n FIGURE G-8  n FIGURE G-9 

STEP 4. Look for black or anechoid areas above
the diaphragm.
Identif y Fluid on FA ST
V ideo or S till Im ag e s
of FA ST
STEP 1. On the pericardial view, look for a black
stripe of fluid separating the hyperechoic
pericardium from the gray myocardium.
This stripe represents fluid.
STEP 2. Look at the hepatorenal space. Intraperi-
toneal fluid has a black hypoechoic or
anechoic appearance.
E va luate Thorac ic and
Lumbar Spine Im ag e s
(op tiona l)
Note: Before interpreting the x-ray, confirm the patient
name and date of examination.
STEP 1. Assess for alignment of vertebral bodies/
angulation of spine.
STEP 2. Assess the contour of the vertebral bodies.
STEP 3. Assess the disk spaces.
STEP 4. Assess for encroachment of vertebral body
on the canal.

STEP 3. Look at the splenorenal space. Blood will

appear as a hypoechoic or anechoic strip in Inter pr e t a Pelv ic X- R ay
this area.

STEP 4. Look around the bladder for an area Note: Before interpreting the x-ray, confirm the patient
of hypoechogenicity. name and date of examination.

STEP 5. Be sure you have thoroughly visualized STEP 1. Check for interruption of the arcuate
all spaces before declaring an examina- and ilioischial lines, including the pubic
tion negative. symphysis. The pubic symphysis should be

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­368 APPENDIX G n Skills

less than 1 cm in pregnancy and less than 0.5 Links to Futur e Le arning
cm in nonpregnant adults.

STEP 2. Check for widening or displacement of
the sacroiliac joints. Check the transverse
processes of L-5 because they may fracture
with sacroiliac disruption.
STEP 3. Check the sacrum for evidence of fracture.
The arcs of the foramina may be interrupted
with sacral fractures.
Post ATLS—Review the FAST performance video
on the MyATLS mobile app. After this course, take
the opportunity to perform FAST and eFAST on
your patients to improve your comfort with use of
this technology. In addition, make an effort to read
pelvic x rays on your own before looking at the
radiologist interpretation.

STEP 4. Check the acetabulum bilaterally for

interruption and femoral dislocation.
Check the femoral head and neck for
disruption bilaterally.

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