Ultrasound-Guided Resuscitation

Use of Ultrasound in the Undifferentiated Hypotensive Patient

Care of the undifferentiated hypotensive patient is a challenge for clinicians, and identifying life-threatening conditions that are readily reversible is a priority. Point-of-care ultrasound (POCUS) has had a prominent role over the past 20 years in the care of these patients. Focus on conditions that require emergent intervention, such as pneumothorax, intraabdominal hemorrhage, and pericardial effusion, has been an important addition to resuscitation practice.

The first description of a POCUS examination for the undifferentiated hypotensive patient was described by Rose et al. This examination protocol involves a focused three-view assessment evaluating for abdominal free fluid, pericardial fluid and cardiac activity, and abdominal aortic aneurysm. Subsequent protocols include additional views. The rapid ultrasound for shock and hypotension (RUSH) examination introduced a multipoint ultrasound (US) examination that includes detailed evaluation of the chest and abdomen to assess for causes of shock. Several other protocols have also emerged with varying numbers of US views. Regardless of the specific protocol involved, each of these protocols focuses on the use of US to rapidly identify etiologies of hypotension, with particular attention to conditions that require emergent intervention. Whether the shock is due to a cardiogenic etiology, an obstructive etiology, hypovolemia, or a distributive cause, an organized scanning protocol will narrow the differential diagnosis. The progress and sophistication in POCUS examinations allow detailed evaluation of the hypotensive patient.