eFAST – Recommended by NICE

The new NICE major trauma guidelines have recommended the use of eFAST as part of the assessment and management of Major Trauma. See the full recommendations here.

From: NICE guidelines [NG39] Published date:

1.3 Management of chest trauma in pre‑hospital settings

1.3.1 Use clinical assessment to diagnose pneumothorax for the purpose of triage or intervention.

1.3.2 Consider using eFAST (extended focused assessment with sonography for trauma) to augment clinical assessment only if a specialist team equipped with ultrasound is immediately available and onward transfer will not be delayed.

1.3.3 Be aware that a negative eFAST of the chest does not exclude a pneumothorax.

1.3.4 Only perform chest decompression in a patient with suspected tension pneumothorax if there is haemodynamic instability or severe respiratory compromise.

1.3.5 Use open thoracostomy instead of needle decompression if the expertise is available, followed by a chest drain via the thoracostomy in patients who are breathing spontaneously.

1.3.6 Observe patients after chest decompression for signs of recurrence of the tension pneumothorax.

1.3.7 In patients with an open pneumothorax:

  • cover the open pneumothorax with a simple occlusive dressing and
  • observe for the development of a tension pneumothorax.

These guidelines also recommend, where indicated, early endotracheal intubation using RSI within 45 minutes of the EMS call, and preferably at the scene of the incident. More evidence to support the case for Advanced Care Paramedics in New Brunswick?


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