In 1997, the American College of Surgeons incorporated the focused assessment with sonography in trauma (FAST) into the Advanced Trauma Life Support curriculum. Since this time, the FAST examination has incorporated various extensions, including the addition of thoracic views creating the extended focused assessment with sonography in trauma (E-FAST). Ultrasonography remains a rapid, reliable, inexpensive, and portable adjunct to the care of the critically injured while crossing the scopes of multiple specialties including surgeons, emergency medicine physicians, and prehospital clinicians. It has essentially replaced the diagnostic peritoneal lavage in unstable patients. Herein, the aim of this chapter is to describe the background, technique, indications, limitations, and practical applications of the use of the E-FAST examination while focusing on the six different sonographic views that compromise the examination. Attention to detail is spent describing both abnormal and normal pathology. By utilizing normal ultrasonographic pictorials, the reader will then be able to gain an appreciation for abnormal pathology.