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Essential
US for Trauma:
E-FAST
Mauro Zago Editor
Ultrasound for Acute Care Surgeons
Series Editor: Mauro Zago
Ultrasound for Acute Care Surgeons
Series Editor
Mauro Zago
For further volumes:
http://www.springer.com/series/10065
Mauro Zago
Editor
Essential US for Trauma:
E-FAST
Editor
Mauro Zago , MD
General Surgery Department
Minimally Invasive Surgery Unit
Policlinico San Pietro
Bergamo
Italy
ISBN 978-88-470-5273-4 ISBN 978-88-470-5274-1 (eBook)
DOI 10.1007/978-88-470-5274-1
Springer Milan Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014939932
© Springer-Verlag Italia 2014
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specifi c statement, that such names are exempt from the
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While the advice and information in this book are believed to be true and accurate at the date of publica-
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material contained herein.
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Springer is part of Springer Science+Business Media (www.springer.com)
To my fi ve darlings
vii
Foreword
Life-and-death situations make trauma surgery one of the most important medical
specialties. In their everyday work, surgeons see the most varied aspects of trauma-
tology. Nonetheless, only those few surgeons who deal with major trauma on a daily
basis have the necessary know-how and skills to save the severely injured patient
from permanent disability or death. There has been one positive spin-off from the
many wars that have been waged in the past centuries: much of what surgeons have
learned on the battlefi eld has come to benefi t civil traumatology.
It is not enough to be a good surgeon with excellent technique. If lives are to be
saved, possible fatal injuries must be recognized at once and dealt with without
delay. The surgeon’s fi rst-line technical resource is radiodiagnostics. The choice of
diagnostic modality will depend on the injury mechanism, the injuries to be expected
therefrom, and fi nally the patient’s hemodynamic situation. An ultrasound study
will almost always be made. In the hands of the surgeon, this is one of the most
valuable tools for decision-making. Depending on the patient’s stability, a survey
can be made of organ injuries and the presence of blood in the peritoneal space,
pleural cavity, and pericardium diagnosed whereby all of these fi ndings can contrib-
ute importantly to the right decision.
Ultrasound (US) is the most used imaging technology, and this book provides
important perspectives on its use in trauma. It is written by experts to provide sug-
gestions, tips, and tricks for the routine clinical use of US. The sonographic anat-
omy of the thoracic and abdominal organs is presented clearly and understandably.
In each chapter, care has been taken to show not just the normal situation but also
abnormal images. The truth of the saying that “one picture is worth a thousand
words” is proven many times over in the clinical scenarios. The E-FAST protocol
and the algorithm for sonography in visceral trauma are new milestones in trauma
diagnostics.
Not to be forgotten is contrast-enhanced ultrasound (CEUS), which is opening
new horizons and becoming increasingly popular. In 2004, the European Federation
of Societies for Ultrasound in Medicine and Biology (EFSUMB) published interna-
tional guidelines for the use of US contrast media. Echo enhancement with CEUS
has signifi cantly improved the sensitivity of detection and visualization of solid
organ injuries. CEUS has its very important advantages over CT and MRI with their
risks and contraindications (among them exposure to radiation, thyrotoxicosis, kid-
ney failure, and anaphylactic shock), loss of time, far greater expense, and lack of
viii
availability in many hospitals. CEUS is now recommended in addition to FAST in
the evaluation and follow-up of traumatic solid organ injuries in stable patients.
Mauro Zago, the editor, took the initiative to create this fi rst volume in a series
devoted to US in routine clinical use in all forms of acute care surgery. This pocket
companion for trauma is intended to help the surgeon performing US in critical situ-
ations to make quicker and better assessments and decisions. Dr. Zago and his con-
tributing authors deserve great thanks for sharing with the reader their knowledge
and their immense experience with ultrasound diagnostics in trauma.
Selman Uranüs, MD, FACS
Department of Surgery
Medical University of Graz
Austria
European Society for Trauma and
Emergency Surgery (ESTES) – Past President
International Association for Trauma Surgery and
Intensive Care (IATSIC) – Past President
Foreword
ix
Pref ace
Welcome to this fi rst issue of the new Springer series, Ultrasound for Acute Care
Surgeons . Ultrasound has a well-established diagnostic role in many surgical dis-
eases, and for specifi c applications (for instance, breast, liver, and vascular surgery),
and is carried out by the surgeons themselves. In the acute setting, however, it is still
not the norm for the surgeon to perform ultrasound. This is a situation that needs to
be addressed, as clinical point-of-care ultrasound frequently assists in the prompt
and appropriate decision-making so important in emergencies. The series is not
intended to “reinvent the wheel”; rather, it simply aims to provide surgeons with
an additional and, in many respects, extraordinary tool that improves the making
of critical (time- and resource-dependent) decisions in numerous clinical situations
confronted in daily practice.
The practical design of each volume in the series is intended to ensure that no
time is lost during consultation. If you are already trained in ultrasound but have
limited experience in this specifi c application, you will be able to rapidly review
technical points, profi t from the described tricks and tips, and go deeper in the clini-
cal chapters. If you are a beginner, trust that learning E-FAST is the easiest way to
gain confi dence with ultrasound and you will rapidly ask to learn more and more
ultrasound applications. If you are not personally interested in applying ultrasound
but are convinced that you must understand the role of E-FAST, you are a smart
doctor, and this book is for you, too.
Sections that at fi rst glance might appear rather technical or boring, such as those
describing knobology or scanning techniques, deserve also to be read by the doctor
already trained in ultrasound. Here, technique is rendered clinically relevant.
Furthermore, every effort has been made to facilitate comprehension and to allow
readers to avoid common mistakes and profi t from the authors’ years of experience
in the specifi c fi eld of trauma ultrasound.
Nothing can replace a formal practical course followed by proctored practice.
However, this book will serve as an ideal quick reference for your personal training:
it will increase your confi dence in the use of ultrasound faster than might be
expected.
The expertise of the authors and the efforts they have expended in ensuring that
this is a very practical book deserve to be highlighted, and I personally thank all of