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Effect of Focused Bedside Ultrasonography in Hypotensive Patients on the Clinical Decision of Emergen 时间:2017-07-12 10:19   来源:未知   作者:admin   点击: 次 Abstract:We assessed the effect of focused point of care ultrasound (POCUS) used for critical nontraumatic hypotensive patients presenting to the emergency department of our hospital on the clinical decisions of the physicians and whether it led to the modification of the treatment modality. This prospective clinical study was conducted at the Emergency Department of Antalya Training and Research Hospital. Nontraumatic patients aged 18 and older who presented to our emergency department and whose systolic blood pressure was <100 mmHg or shock index (heart rate/systolic blood pressure) was >1 were included in the study. While the most probable preliminary diagnosis established by the physician before POCUS was consistent with the definitive diagnosis in 60.6% () of 180 patients included in the study, it was consistent with the definitive diagnosis in 85.0% () of the patients after POCUS (). POCUS performed for critical hypotensive patients presenting to the emergency department is an appropriate diagnostic tool that can be used to enable the physicians to make the accurate preliminary diagnosis and start the appropriate treatment in a short time.
1. Introduction
  Shock is a condition of acute circulator failure that leads to decreased organ perfusion due to insufficient oxygen supply to the tissues [1]. The effects of oxygen insufficiency are initially reversible; however, they may quickly become irreversible. As shock progresses, it results in consecutive cell death, target organ damage, multiple organ failure, and death [2].
Today, emergency departments are the places where patients with poor overall condition and critical patients access healthcare services. Majority of these critical patients have shock and hypotension of unknown cause. Diagnostic procedures and treatment have to be performed simultaneously during the medical care of these critical patients at the emergency department. If the diagnostic tests to be used to evaluate these patients are cheap, fast, and applicable at bedside, this will facilitate the work of the clinicians who race against time. One of the diagnostic tests is the use of point of care ultrasound (POCUS) that has been used by emergency medicine specialists for decades especially for traumatic patients and recently applied to critical patients as well. POCUS is getting more important in emergency medicine practices since it is reliable, rapid, noninvasive, and applicable at bedside [3].
  Mortality rates in shock patients vary depending on the cause. While mortality due to septic shock is 40%–60%, mortality due to cardiogenic shock ranges between 36% and 56% [4]. It is very important to establish the diagnosis accurately and start the treatment early before organ dysfunction develops in order to reduce the morbidity and mortality in patients with shock. The definitive diagnosis of shock can be established early at the emergency department only in 25% to 50% of the cases [5, 6]. The accuracy of the diagnosis rises up to 80% with the use of POCUS performed in emergency department protocol [6]. The most important goal for the clinician is to determine the etiology of the current condition and avoid any delays in the supportive therapy.
Several resuscitation protocols in which ultrasound is used at an early stage for the care of critical patients have been developed recently [7–13]. Each of these protocols contains the same core ultrasound components; on the other hand, the most important difference between these protocols is the order of procedure priority. The RUSH (Rapid Ultrasound in Shock) protocol is one of the most comprehensive and effective ultrasonographic examination protocols for early detection and treatment. The RUSH protocol is evaluated at 3 respective steps (the pump, the tank, and the pipes) [8].