Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

Abstract

On behalf of all authors, the corresponding author states that there is no conflict of interest. ABSTRACT Purpose:We analyzed the efficacy of a point-of-care ultrasonography protocol, based on a focused multi-organ examination, for the diagnostic process of symptomatic, non-traumatic hypotensive patients in emergency. Methods

Echography is mandatory for the initial management of critically ill patients: No

“…d Ultrasound abdominal examination in another critically ill patient with sepsis from acute cholecystitis. In this case, the combination of thickened walls with pericholecystic fluid and gallstones make the ultrasound diagnosis of acute cholecystitis more specific differential [4]. When there is a suspicion of cholecystitis in critically ill patients with sepsis, US may be of help.…”

“…These cases mandate consideration of adjunctive and more complicated US signs, and multiorgan US approaches including echocardiography (Fig. 1c), [3,4]. Even though the use of US as a guide of thoracentesis during the procedure has recently been considered standard of care, the safety advantages of US for thoracentesis might be tracked particularly for mechanically ventilated patients rather than for the whole ICU population [5,6].…”

Echography is mandatory for the initial management of critically ill patients: We are not sure

“…Our discussion will concentrate on whether intensivist performed ultrasonography is mandatory for the initial management. This would typically include a whole body approach that combines elements of cardiac, thoracic, vascular and limited abdominal ultrasonography as described initially by Lichtenstein et al and more recently by Volpicelli et al [7,8]. We adopt a position of clinical equipoise for the following reasons.…”

Echography is mandatory for the initial management of critically ill patients: Yes

“…Undifferentiated hypotension in the emergency department should be guided by cardiac ultrasound after a standard 12-lead EKG has been obtained [10]. Mandatory assessment includes cardiac, lung, abdominal and inferior caval vein ultrasound.…”