Clip 1: Initial ultrasound shows a very subtle positive anachoic stripe of free fluid in the hepatorenal space.
Clip 2: Repeat ultrasound about 15 mins later with the patient in Trendelenburg is now clearly positive.
A middle aged patient is stabbed in the abdomen. Resuscitation ensues, primary survey, big lines, etcetera. The wound is about 1 cm in diameter, mid abdomen, not bleeding on visual inspection. BP is 160s systolic. HR in the 110s. Patient is answering questions appropriately.
Performed simultaneously with the initial resuscitation, POCUS RUQ (Hepatorenal space) of the EFAST is thought to be subtly positive, arguably equivocal (Clip 1 above). On repeat about 15 mins later, there is now a clear anechoic strip in the hepatorenal space (Clip 2 above). The patient was transfused blood in the resuscitation bay and went to the OR. There was a complete transection of the inferior epigastric artery and about 1000cc of hemoperitoneum. The wounds were repaired and the patient did well.
Sono pearls: Serial EFAST exams can elucidate the presence of new findings, or the expansion of, as in this case, equivocal or subtle findings. More pearls: Gravity can help. If hemoperitoneum is the concern, use Trendelenburg positioning when evaluating the RUQ. If pneumothorax is the concern, use reverse Trendelenburg and assess the apices of the lungs for lung sliding.