4. eFAST Exam Protocol

Step 4: eFAST Cardiac View

eFAST Cardiac View: Does my patient have a pericardial effusion with cardiac tamponade?

The subxiphoid view is the preferred scan to evaluate the heart and assess for any pericardial fluid. However, the subxiphoid view can be difficult to obtain in some situations (e.g. patient body habitus or abdominal pain with trauma). If the subxiphoid view cannot be obtained, a parasternal long axis view is recommended.

*Editor’s Note: In this post, we will be pointing the indicator based on the abdominal/eFAST ultrasound preset. When you are in the dedicated cardiac mode preset the indicator will be pointing 180 degrees in the opposite direction.

Cardiac Subxiphoid View

  • Hold the probe in the palm of your hand and use an overhand grip.
  • Point the probe indicator towards the patient’s right with the ultrasound machine depth set to around 15-20 cm.
  • Using the liver as the acoustic windowsimultaneously press the probe into the patient’s abdomen while tilting the tail of the probe towards the patient’s feet
  • Aim the ultrasound beam towards the patient’s left shoulder.
eFAST Subxiphoid View Probe Position
  • Identify the liver, pericardium, right atrium, right ventricle, left atrium and left ventricle
Subxiphoid View Ultrasound Echocardiography Video POCUS
eFAST Subxiphoid View Structures
eFAST Subxiphoid View Structures (Illustration)

Cardiac Parasternal Long Axis

Consider obtaining the parasternal long-axis view of the heart in a patient when you are unable to obtain the subxiphoid view. Otherwise, proceed to scanning the lungs.

  • Grasp the linear probe between your thumb and first finger, like holding a pencil.
  • Anchor your third and/or fourth finger(s) in the 2nd or 3rd left intercostal space, just lateral to the sternum.
  • Probe indicator towards the patient’s left hip with the machine depth set approximately 10-15 cm
eFAST Parasternal Long Axis View Probe Position
  • Identify the pericardium, mitral valve, aortic valve, right ventricle, descending aorta, left atrium, and left ventricle
  • You may have to move up or down a rib space to identify the structures
Parasternal Long Axis View Ultrasound Echocardiography Video eFAST FAST scan POCUS
eFAST Parasternal Long Axis View Structures
eFAST Parasternal Long Axis View Structures (Illustration)

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