Ultrasound Assessment of patients in shock

Author: Mehrad Ramazany / Editor: Frances Balmer / Codes: / Published: 01/01/2022

Learning Objectives

• Use POCUS as an adjunct in the initial assessment of patients with undifferentiated shock 
• Understand the RUSH protocol 
• Be familiar with the SHOc protocol
• Be familiar with common abnormalities seen on POCUS

References

1. Tuzovic, M., Adigopula, S., Amsallem, M. et al. Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile. Int J Cardiovasc Imaging 32, 389398 (2016). https://doi.org/10.1007/s10554-015-0780-
2. Lichtenstein D, Mezire G, Biderman P, Gepner A. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000 Oct;26(10):1434-40. doi: 10.1007/s001340000627. PMID: 11126253.
3. Lichtenstein DA, Mezire G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005 Jun;33(6):1231-8. doi: 10.1097/01.ccm.0000164542.86954.b4. PMID: 15942336.
4. Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013 Sep 23;17(5):R208. doi: 10.1186/cc13016. PMID: 24060427; PMCID: PMC4057340.
5. Milne J, Atkinson P, Lewis D, et al. Sonography in Hypo- tension and Cardiac Arrest (SHoC): Rates of abnormal findings in undifferentiated hypotension and during cardiac arrest as a basis for consensus on a hierarchical point of care ultrasound protocol. Cureus 2016;8(4):e564. doi:10.7759/ cureus.564.
6. Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W. Nomenklatur, Definition und Differenzierung der Schockformen. Dtsch Arztebl Int. 2018;115(45):75767.
7. Javali RH, Loganathan A, Srinivasarangan M, Patil A, Siddappa GB, Satyanarayana N, et al. Reliability of emergency department diagnosis in identifying the etiology of nontraumatic undifferentiated hypotension. Indian J Crit Care Med. 2020;24(5):31320.
8. Shokoohi H, Boniface KS, Pourmand A, Liu YT, Davison DL, Hawkins KD, et al. Bedside ultrasound reduces diagnostic uncertainty and guides resuscitation in patients with undifferentiated hypotension. Crit Care Med. 2015;43(12):25629.
9. Atkinson P, Bowra J, Milne J, Lewis D, Lambert M, Jarman B, et al. International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest. CJEM. Cambridge University Press; 2017;19(6):45970.
10. Perera, P. et al. The RUSH Exam 2012: Rapid Ultrasound in Shock in the Evaluation of the Critically Ill Patient. Ultrasound Clinics 7 (2012): 255-278.

Additional Resources