One continuous eFAST study on a handheld probe — thoracic, subxiphoid, both upper quadrants and the pelvis — with every window timestamped, the depth and frequency read off the screen, and the whole thing transcribed.
Sobre a Dra. Mariz
I am Dr. Fernando Mariz, a gynecology and pelvic surgery physician practicing in New York City. Before my medical career, I served in the U.S. Marine Corps, where I developed the discipline, focus, and steadiness that continue to shape the way I care for patients today. At Maiden Lane Medical, my work covers women’s health, preventive care, sonography, pelvic pain, abnormal uterine bleeding, and minimally invasive gynecologic procedures.
Sobre o Dr. Avila
I am Dr. Jailyn Avila, an emergency medicine physician, educator, and digital health innovator based in Southern California. My clinical work is rooted in emergency care, while my teaching focuses on point-of-care ultrasound, residency education, and practical training for physicians. Through my roles with Emergent Medical Associates, UHS SoCal MEC Emergency Medicine Residency, Core Ultrasound, and FemInEM, I work at the intersection of patient care, medical education, and accessible digital learning.
Resposta rápida
The eFAST exam is a bedside ultrasound sweep that asks one question in five places: is there fluid where fluid should not be, and is the lung sliding? It covers the pericardium, the right upper quadrant, the left upper quadrant and the pelvis for free fluid, and both hemithoraces for pneumothorax and haemothorax. Free fluid reads anechoic — black — in a space that should not contain it. Practised, the whole sequence runs in under five minutes; the fourteen minutes here are teaching time, with the machine adjustments and the reasoning left in. The walkthrough on this page runs it in one pass on a handheld probe, moving between the linear, curvilinear and sector settings of a single transducer rather than swapping hardware between windows. My advice for a first watch: take the thoracic and right-upper-quadrant segments end to end, then run the rest at speed.
Looking for a device rather than the exam? The emergency medicine hub compares the models used for trauma work, and the Página do produto D3Ultra carries the full specification and current price.
The fourteen-minute line
Where the time actually goes
Ten passages, drawn to scale against the 14:09 runtime. The longest single stretch is the inferior vena cava — and the presenter says himself that the IVC is not part of the eFAST protocol. Click any row to jump the video to it.
0:00Setup and the rule of the exam34sDevice idle0:34Anterior lung, second intercostal space41sLinear1:15A-lines, B-lines and what each one means1m 44sLinear2:59Lung base and the costophrenic angle56sLinear3:55Subxiphoid cardiac window1m 53sPhased/sector → curvilinear5:48Inferior vena cava2m 24sCurvilinear8:12Right upper quadrant2m 21sCurvilinear10:33Left upper quadrant1m 53sSector → curvilinear12:26Pelvic1m 31sCurvilinear13:57Fechar12sCurvilinear
eFAST windowadjunct, outside the protocolsetup and close
The left thoracic window is not scanned on camera. At 3:50 the presenter says he would repeat the thoracic window on the other side; the recording moves to the heart instead. Bilateral thoracic views are part of the protocol.
Timestamped
Key moments, with the settings
The third column is the part that is normally missing from a scan video: the preset, depth and transmit frequency showing on the device at that moment. They change five times across the study, and those changes are the teaching.
| Tempo | What is on screen | Transducer, preset, depth, frequency |
|---|---|---|
| 0:00 | Setup and the rule of the examThe presenting clinician frames the study: one trauma question, fluid, and a target of under five minutes once the sequence is familiar. He names the three transducer geometries the unit offers before touching the patient. | Device idle · three geometries available · software V 3.6.73 |
| 0:34 | Anterior lung, second intercostal spaceProbe placed between the ribs in the second intercostal space; the patient takes a breath and the operator watches for pleural sliding. M-mode is switched on to separate the seashore sign from the barcode sign when sliding is hard to call by eye. | Linear · Breast preset · D 60 mm · F H10.0 MHz · GN 80 dB · DR 70 · B + M mode |
| 1:15 | A-lines, B-lines and what each one meansFrozen linear image with A-lines visible. The clinician identifies them as a reverberation artifact off the pleural line, notes they appear in both normal lung and pneumothorax, and contrasts them with comet-tail artifacts and confluent B-lines in wet lung. | Linear · Breast preset · D 60 mm · F H10.0 MHz · MI 0.9 · TIS 0.2 |
| 2:59 | Lung base and the costophrenic angleProbe moved to the lung base. Lung sits directly on liver with no anechoic wedge above the diaphragm — the curtain sign, and no pleural effusion. He notes that a few thin B-lines here are normal, particularly in older patients. | Linear · D 60 mm · frozen frame · lung–liver interface |
| 3:55 | Subxiphoid cardiac windowSector setting selected for a subxiphoid four-chamber view, looking for pericardial fluid. The clinician then switches to the curvilinear setting and corrects depth, because on this unit the abdominal setting resolves fluid around the heart better than the cardiac one. | Phased/sector → curvilinear · Cardiac preset · D 130 mm · F H4.0 MHz · GN 105 dB · DR 80 |
| 5:48 | Inferior vena cava — an adjunct, not part of the protocoladjunctThe transducer is rotated 90° from the subxiphoid position onto the IVC. He states plainly that this is outside the explicit eFAST protocol, then gives the numbers he reads it against: roughly 1.5–2.5 cm, collapsing about 50% with the respiratory cycle. He also demonstrates finding a structure in short axis first and rotating into long axis. | Curvilinear · Abdomen preset · D 240 mm · F H5.0 MHz · GN 80 dB · DR 80 |
| 8:12 | Right upper quadrant — perihepatic viewLiver and right kidney in one frame, with the hepatorenal recess in the middle of the image. Rib shadowing is shown as a real obstacle, and the fix is demonstrated: come in under the costal margin and angle up rather than fight the intercostal space. | Curvilinear · Abdomen preset · D 240 mm · F H5.0 MHz · GN 80 dB · DR 80 · ENH 2 |
| 10:33 | Left upper quadrant — perisplenic viewThe harder window of the two. Ribs block the subcostal approach on the left, so the clinician tries the sector setting, finds the image too dark even after increasing depth, and returns to the curvilinear setting to sweep the splenorenal space between the ribs. | Sector → curvilinear · Abdomen preset · D 160 mm · F H5.0 MHz · GN 80 dB · DR 80 |
| 12:26 | Pelvic — suprapubic view in two planesProbe placed above the pubic symphysis with the bladder filling the near field. He sweeps transverse and sagittal, names the dependent spaces — rectovesical in men, rectouterine in women — and points out that the only anechoic fluid that belongs in this frame is inside the bladder. | Curvilinear · Urology preset · D 160 mm · F H5.0 MHz · GN 80 dB · DR 80 |
| 13:57 | Close — sequence is flexible, coverage is notThe exam ends on the pelvic view. The order of the windows can be reversed to suit the room, but each one is swept in both planes and every window is read for fluid outside the structure that should contain it. | Curvilinear · Urology preset · D 160 mm · frozen frame |
Settings transcribed from the device interface visible in the recording (software V 3.6.73). Depth is the D value on screen; frequency is the F value, harmonic. Where the presenter changes a setting mid-window, the value at the start of the window is given.
Reading the images
What this scan shows
Every eFAST window asks the same question in a different place: is there anechoic fluid where there should be none? In the right upper quadrant it is the hepatorenal recess, between liver capsule and right kidney, where blood collects first in a supine patient. In the left upper quadrant it is the splenorenal interface, which sits higher and further posterior — which is why the presenter fights the ribs there for two minutes. In the pelvis it is the space behind the bladder, rectovesical in men and rectouterine in women. Around the heart it is the pericardial sac, seen from below the xiphoid so the liver acts as the acoustic window.
The thoracic windows are what make the exam “extended”, and they invert the logic: instead of fluid, you are looking for movement. Pleural sliding on a linear probe means the two pleural layers are still in contact. When sliding is hard to call by eye, M-mode settles it: a granular seashore pattern below the pleural line means the lung is moving, and flat parallel lines, the barcode sign, mean it is not. A-lines are a normal reverberation artifact and appear in healthy lung and in pneumothorax alike, so they do not decide the question alone. B-lines are the opposite finding: comet-tail artifacts from wet lung, normal in ones and twos, abnormal when confluent.
Frequency choice is what makes any of it visible. The lung windows here run at 10 MHz on the linear setting at 60 mm, because pleural sliding is superficial and resolution matters more than penetration. The abdominal windows run at 5 MHz on the curvilinear setting at 160–240 mm, because the hepatorenal recess in an adult sits beyond the reach of a high-frequency probe. Get that backwards and the finding is not subtle: it is simply absent from the image.
Verbatim
Full transcript
Transcript — 14:09, 20 passages
Transcribed from the recording and edited for readability; square brackets mark an editorial clarification, and every timestamp jumps the video.
Setup
0:00Hello. I plan to do a quick eFAST exam. I’m going to explain a little bit, but of course, if you want a detailed explanation, see my full lecture on the topic. I’m going to be using this 3-in-1 Chinese unit, which has a pretty good linear, has an okay curvilinear, and does have a cardiac sector probe function. Let’s start that eFAST exam. With practice, you should be able to do this in less than five minutes, right? And remember, eFAST — we’re looking for fluid, because this is a trauma exam.
Anterior lung
0:34Okay, so we’re going to start with lungs, and I’m going to start basically second intercostal space. I’m actually going to turn this on to M-mode. I don’t necessarily need M-mode, I don’t think. And I’ll change the depth here a little bit deeper. So you want between the ribs, and you have the patient take a breath, and you look for pleural sliding. Sometimes that’s hard to see, so you look at the M-mode and you look to see if it’s more barcode sign or more seashore sign. What will happen is you’re looking for basically ants moving across this line.
1:15And we see A-lines here, which is a reverberation artifact from the reflection with the pleura and the surface, so they’re equidistant to this distance. And you see that in pneumothorax and in normal lungs. If the lungs are wet, if there’s fluid in the lungs, we get comet-tail artifacts or B-lines, and we can get like a giant comet-tail artifact — [that] would be confluent B-lines. And next, we can continue and we can go down a little bit lower and check again.
1:52The other day I was doing this and I could actually see the fissure moving back and forth. You can see the fissure. Neat. We can check another location. I have enough gel here. Okay, and we can take our gel and we can go on to the side. We can look there as well. Okay, that’s good there, and I would recommend going sort of to the bottom corner. So, get between the ribs here.
Lung base
2:59You can see that the lungs come into view, right there. Let’s freeze that. So this is lung, and this was liver. And if there was fluid in the lungs, at this costophrenic angle, this pleural space here, we would see a hypoechoic sort of triangle of fluid here, basically at the bottom of the diaphragm — but we don’t see that. We basically see lung straight to liver. So again, we’d see [an] anechoic basically triangle here at the surface of the diaphragm if there was an effusion, if there was fluid there, and we don’t. This is called curtain sign. And we could also look for B-lines here, but we don’t — we get A-lines. This is normal-looking lung. A couple skinny B-lines are normal, particularly in the elderly. Okay, so I would repeat that on the other side as well.
Subxiphoid cardiac
3:55So now the next view is the subcostal, or subxiphoid, view of the heart. We’re again looking for fluid, pericardial fluid. I have it on the cardiac setting here. You can sort of see the probe orientation. And so we’re looking for hypoechoic fluid here and here — pericardial.
4:26I actually don’t find, particularly on this setting since I have the options — the cardiac setting I find is perhaps better at looking at the actual chambers, and in particular if I’m looking at the long axis view, parasternal view, I find that sector probe view or setting on this quite useful. Since I have all three options here — like, learn your equipment, learn the instrumentation you have access to — the abdomen setting actually will give me a better picture for looking for fluid, I think.
4:58So if I unfreeze that — now the depth is too deep. Let’s change the depth here. [Too] shallow. Right. Like, look at that. I can see all around the heart. The other one was just too dark, the whole thing, but now I can see all sorts of different types of tissue. And I feel like I could get a much better idea about whether there’s fluid around the heart or not with the curvilinear setting. If I freeze this, I’d be looking for a fluid collection here and up here — that’s where I’d be looking.
Inferior vena cava
5:48Now next, a lot of people, since you’re in the area, they rotate the transducer 90 degrees and they look at the inferior vena cava. So this isn’t part of the explicit eFAST protocol, but since you’re already in the area and you already have the sector probe or the curvilinear probe — and both of those will capture the inferior vena cava quite perfectly — you might as well take a quick look. And there is a reason to look at it in cases of trauma. It does give you some useful information qualitatively, even just with a quick look.
6:23So here you can see the transducer orientation here, and I can unfreeze that and I can get a picture of that. And as I breathe, you should see it sort of compress a little bit — and compressing around 50% with breathing cycles is about normal. In terms of the size, you expect it to be in between about 1.5 to 2.5 centimetres. If it is, let’s say, enlarged, and if it doesn’t really compress — if it doesn’t compress at least about 50% and it’s enlarged and dilated — and when it’s dilated you’ll see these lines become more parallel, and sometimes it really doesn’t compress at all. That can mean some sort of obstruction, some sort of cardiac pathology.
7:04If it is entirely compressed and it’s small and it’s very compressed — if you have trouble finding it, you may look in short axis view, find it, and then rotate the transducer once you have it centred on the transducer. I find that’s a useful way of finding structures: you find them in short axis first. When you want [a] long axis picture, you find them in short axis first and then rotate. In fact, let me do a little example of that. So there it is, and I make sure that’s in the centre, and then I very carefully rotate, and then it should appear in my long axis. And there we go.
7:39Of course, as you move around — there we go, there’s a perfect picture again. And again, mine compresses just a little bit, which is normal, and it’s about the right size. If it’s too small — if it is too small, less than that 1.5, or it’s completely collapsing all over the place — then that can indicate you don’t have enough blood, the person’s bleeding out bad. So in trauma cases, that’s where you’re checking. You’re checking and you’re like, okay, this person’s running out of blood, what’s going on? It might be internal bleeding, for example.
Right upper quadrant
8:12So now for the perihepatic view. And for the perihepatic view, either curvilinear or sector probe or phased array probe — I use those two terms interchangeably. And if you are using the sector probe, which is the recommended probe, you’d be looking between the ribs. You’ll see, for example, here if I try to put the curvilinear sort of on the ribs, you can see there’s so much shadowing from the ribs. Between the 10th to 11th rib is roughly where they recommend you put [it]. And I can see — look, I can see a little bit, so it’s not impossible — but I could come, for example, underneath and look upwards, and then I avoid that rib problem. So again, learn your machine. Practice, practice, practice.
8:58Because this is a great view. Look, I can get a good view of the liver and the kidney. And this is the space I’m looking for. This is [Morison’s] pouch here. So this is a great view, and I would scan through the kidney to see if there’s fluid here. And of course, you could scan everywhere for fluid. Of course, if you’re looking this low, this assumes you’ve checked the corner of the lung — because in the eFAST protocol, they’re sort of assuming you’re checking the corner of the lung, above the diaphragm, and you’re checking the [Morison’s] space and all around the kidney, and you’re doing that all from basically the same location.
9:34But I already did a lung view and I already checked the bottom of the lungs with the linear view, so I can just really focus on [Morison’s] space right now. And I don’t necessarily need to check the corner of the lungs, because I did that with the linear transducer instead. In which case, for me, as I mentioned, if I’m using curvilinear, I’d probably go underneath the lung so there’s no shadowing and I can just sweep through. If I do switch it to the sector probe, of course, I would be able to see between [the] lungs. I’ve mentioned that [with] this three-in-one, the curvilinear setting is much better than the sector probe setting or option. So the curvilinear is the way to go for me. So I would probably go — again, I have the option — I could go underneath and scan through. Yeah, no, no fluid around that kidney. And again, I could try to go through the ribs. And you can do it. Again, if I had a [dedicated] sector probe, that’s what I would do.
Left upper quadrant
10:33And now we’re on the perisplenic view. So the other one was perihepatic, right upper quadrant; now we’re in left upper quadrant, and we want to unfreeze it here. And again — oh, those ribs are getting in my way. And I can try to sort of go underneath and upwards to try to get a picture of that. Upwards. So there we go. You can look around the kidney. To come up higher to get the spleen, we really don’t have an option; it’s harder to see underneath.
11:14Let me try the sector probe setting. [It] only turns on if you hit cardiac. And I can increase depth here. It’s quite dark. It’s quite dark, but I can still make out around the edges there. Right. No fluid there. I’ll go back to curvilinear. So even between the ribs, I can still get a good idea if there’s fluid around the spleen. And I can move around the transducer to try to see the space between. Again, I’d be looking in this space and make sure that there’s no fluid there, and I would screen through. It’s hurting my shoulder a little bit, trying to do this on myself — of course, you’re doing this on someone else — and you’d sweep through and screen through basically the entire structure.
Pelvic
12:26So lastly, we have the pelvic view, or the suprapubic view. So it’s way down above the pubic symphysis. And we’re going to look in both planes, and we’re just going to be screening through. We’re looking for fluid, which will be basically around the bladder. So you want whatever settings gives you a good view of the bladder and structures around the bladder. For men, you look for fluid more between the bladder and the rectum. For women, you’d look for fluid more between the bladder and the uterus — of course, men aren’t going to have a uterus. And you just screen through in both planes.
13:06So here, if I find my mouse cursor here, and I unfreeze that, and I’m in, let’s say, vertical, and I could screen through — and I don’t see a fluid collection. So if I freeze here, just to talk about structures here: we have bladder, and then we have rectum here. So I’d be looking around here. Of course, you could find fluid anywhere. All the anechoic fluid should be inside the bladder; we shouldn’t see anechoic fluid outside the bladder, right? So you’re just looking for fluid collections in other locations. And I can rotate this and screen through in the other direction. And I can screen through.
Fechar
13:50Well, you can see the rectum there underneath the bladder, and there’s no fluid collection. Okay, that’s done. Now, if you prefer, you could do it in the reverse order than I did. But regardless, just screen through it in both planes, looking for fluid outside of the bladder. And that’s it. That’s an eFAST exam.
Hardware
Device and settings
One probe covers the whole study. The left column is the published specification; the right column is what the device interface actually showed while this exam was being run, and that second column is the one I would work from if you are reproducing it. A three-in-one head is the right buy when you scan pleura and abdomen in the same shift. If your trauma work is deep abdominal only, this is not a good fit: buy a dedicated curvilinear probe instead.
Published specification
Suresult D3Ultra
Convex · linear · phased in one head — $2,976
- Convexo3.2 / 5.0 MHz · 90–300 mm · 45°
- Linear7.5 / 10 MHz · 20 / 40 / 60 / 100 mm · 40 mm
- Faseado3.2 / 5.0 MHz · 90–300 mm · 60°
- ModosB, M, Color Doppler, Power Doppler, PW Doppler
- Array192 elements · 64 channels · 256 grey levels
- Gain / DR30–105 dB · 40–110
- Body156 × 65 × 20 mm · 263 g · 2 h scanning
- PlataformaiOS, Android, Windows · dual-band Wi-Fi
Read off the screen in this recording
- ThoraxLinear · Breast preset · D 60 mm · F H10.0 MHz · GN 80 dB · DR 70
- CardíacoCardiac preset · D 130 mm · F H4.0 MHz · GN 105 dB · DR 80
- IVC / RUQAbdomen preset · D 240 mm · F H5.0 MHz · GN 80 dB · DR 80
- LUQAbdomen preset · D 160 mm · F H5.0 MHz · GN 80 dB · DR 80
- PelvisUrology preset · D 160 mm · F H5.0 MHz · GN 80 dB · DR 80
- OutputMI 0.7–0.9 · TIS 0.1–0.2 · ENH 2
- SoftwareV 3.6.73 · B and B+M used, no Doppler in this study
- Operator noteSector setting tried at the cardiac and left upper quadrant windows; curvilinear preferred at both, stated at 4:53 and 10:02
Same device, other windows
Related scans
9:28POCUS lung exam — the BLUE protocolA-lines, B-lines, lung sliding and the lung point, run as a protocol rather than a single window.Watch in the Library →
1:23DVT: the three-point compression scanCommon femoral, femoral and popliteal veins, compressed in sequence on a linear probe.Watch in the Library →
6:42POCUS for rib fracture detectionHigh-frequency linear survey of the rib cortex, and what a cortical step-off looks like on screen.Watch in the Library →All the clinical clips, filterable by anatomy and probe, are in the Scan Library.
Asked on this search
eFAST questions
What are the six sites of an eFAST exam?
The eFAST exam covers the pericardium, the right upper quadrant, the left upper quadrant, the pelvis, and both hemithoraces for pneumothorax and haemothorax. The four abdominal and cardiac windows are the original FAST scan; the thoracic windows are the “extended” part. In the walkthrough above the clinician runs the thoracic window first and finishes on the pelvis, then says explicitly that the order can be reversed. I would learn it in his order and keep it: a fixed sequence is what stops a window being skipped under pressure.
Source: ACEP Sonoguide — FAST. Accessed September 5, 2026.
What is the difference between a FAST and an eFAST exam?
A FAST exam looks for free fluid in the pericardial sac and in the dependent spaces of the abdomen. An eFAST exam adds the lung windows, so it also answers whether there is a pneumothorax or a haemothorax. The American College of Emergency Physicians describes the “extended” portion as the part of the study that evaluates the thorax.
Source: ACEP Sonoguide — FAST. Accessed September 5, 2026.
How long does an eFAST exam take?
Under five minutes once the sequence is familiar. That is the target the presenting clinician sets in the first thirty seconds of this walkthrough, and it matches the figure the Merck Manuals give for the study. The fourteen minutes here are teaching time: the scan itself is a fraction of that, and the rest is explanation, machine adjustment and repeated demonstration.
Source: Merck Manuals — How To Do E-FAST Examination. Accessed September 5, 2026.
What does free fluid look like on an eFAST scan?
Anechoic — black — and in a place that should not contain it: a wedge above the diaphragm, a stripe in the hepatorenal recess, a rim around the heart, a collection outside the bladder. The clinician states the test directly at the pelvic window: the anechoic fluid that belongs in that frame is inside the bladder, so anything anechoic outside it is what you are looking for.
Stated by the presenting clinician in the recording above.
Can an eFAST exam be done on a handheld ultrasound?
Yes. This walkthrough is one continuous handheld study covering the thoracic, cardiac, right upper quadrant, left upper quadrant and pelvic windows on a single wireless probe. What decides the exam is geometry, not form factor: the operator moves between the linear, curvilinear and sector settings of one three-in-one probe, and says which of them he prefers at each window. I would buy for the windows you scan most — a three-in-one head covers all five here, and a dedicated curvilinear is the better tool if your trauma work is abdominal only.
Stated by the presenting clinician in the recording above.
Provenance
Fontes
- ACEP Sonoguide — FASTAmerican College of Emergency Physicians. “FAST”, Sonoguide. Definition of the exam and of the “extended” thoracic component. Accessed September 5, 2026.
- Merck Manuals — How To Do E-FAST ExaminationHabrat, D. Merck Manual Professional Version, Critical Care Medicine. Protocol scope and the figure the manual states directly: the E-FAST examination should be completed in under five minutes. Accessed September 5, 2026.
- SAEM CDEM — FAST ExamSociety for Academic Emergency Medicine, Clerkship Directors in Emergency Medicine. Windows and structures imaged in the FAST examination. Accessed September 5, 2026.
- Extended Focused Assessment with Sonography for Trauma (eFAST) — PMCBella, F. M. et al., 2025. PMC12112529. Scope of the peritoneal, pericardial and pleural assessment. Accessed September 5, 2026.
- Página do produto Suresult D3UltraProbe geometries, frequency ranges, scanning depths, imaging modes, element and channel counts, and weight, as published in the product attribute table. Accessed September 5, 2026.
- Suresult channel — the video on this page“14-Min eFAST Trauma Scan”, published 3 July 2025. Duration 14:09. Transcript below is drawn from this recording. Accessed September 5, 2026.
Which geometry does your trauma bay actually need?
An eFAST needs a low-frequency window for the abdomen and a high-frequency one for the pleura. Some teams cover that with one three-in-one probe; some are better served by two dedicated ones. Tell us the room and the case mix and you will get a direct recommendation in one conversation — one probe, two, or neither.
