Thursday, May 22, 2014

FALLS (protocolo)

 thebluntdisecction - MAY 21, 2014 - BY CHRIS PARTYKA
"Below is the main content discussed at an ultrasound workshop I ran this week at the Sydney HEMS Clinical Governance Day.
Whilst the bread & butter use of prehospital ultrasound would have to be an extended-FAST scan in the setting of trauma, I decided to focus more on utility of basic ECHO & lung ultrasound in the assessment of shocked medical patients.
A lot has been written about the RUSH protocol and its role in aiding the diagnosis of undifferentiated shock/hypotension. From my own experience (in initiating patient transfers, not conducting them), a source of shock is largely defined by the time an inter-hospital retrieval takes place (ie. abdominal aortic aneurysms excluded by history, examination or ED ultrasound).
When faced with the ongoing ED-based resuscitation of shocked patients (esp. those with septic shock & refractory hypotension), I find myself using a process similar to Lichtenstein’s FALLSprotocol which I believe can be carried into the arena of retrieval medicine to guide ongoing therapy (and potentially alter outcomes)."