Wednesday, April 19, 2017

Sonography in Hypotension and Cardiac Arrest

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CanadiEM -  By David Lussier - April 18, 2017
"Cardiac arrest and hypotension are synonymous with emergency medicine. Over the years, point of care ultrasound (PoCUS) has become an extension of our stethoscope. The recently published consensus statement from the International Federation for Emergency Medicine (IFEM) aims to provide guidance for PoCUS use in these situations, and describes the Sonography in Hypotension and Cardiac Arrest (SHoC Consensus) protocols.
The guidelines were developed based upon expert consensus formulated using three rounds of a modified Delphi approach. Recommendations were based on existing protocols and relevant literature. Disease incidence was also considered, and scanning is to be prioritized based on clinical probability.
Ultimately, two protocols were developed, one for cardiac arrest and one for undifferentiated hypotension. Each protocol included core views, which are performed routinely for all patients; supplementary views, which are only performed on a case by case basis; and additional scans, which are performed when additional investigation is required. When interpreting each view, it is important to investigate each of the “4 Fs”: fluid, form, function, and filling. This approach is illustrated below using two cases."