Portal de Periódicos da CAPES

Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension

2009; BMJ; Volume: 26; Issue: 2 Linguagem: Inglês

10.1136/emj.2007.056242

1472-0213

Paul Atkinson, Duncan McAuley, Richard Kendall, Oshaani Abeyakoon, C. Reid, Jim Connolly, David A. Lewis,

Renal function and acid-base balance

Background: Non-traumatic undifferentiated hypotension is a common critical presentation in the emergency department. In this group of patients, early diagnosis and goal-directed therapy is essential for an optimal outcome. The usefulness of focused bedside ultrasound is reviewed and a protocol for Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) is proposed. Methods: The protocol consists of six windows including cardiac, peritoneal, pleural, inferior vena cava and aortic views, and aims to shorten the time period taken to establish a diagnosis and hence to deliver the most appropriate goal-directed therapy. Its use in seven case examples is described. Results: In all cases the ACES protocol helped in guiding the initial management while further information was obtained. Conclusion: The six-view ACES protocol is a useful adjunct to clinical examination in patients with undifferentiated hypotension in the emergency department. A prospective randomised trial or multicentre database/registry is needed to investigate the validity and impact of this protocol on the early diagnosis and management of hypotensive patients.