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Point of Care Ultrasound Shock Protocols for Patients’ Bedside Assessment, Diagnosis, and Treatment of Tamponade: a Case Report and Literature Review

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Abstract

Point-of-care ultrasound reduces diagnosis uncertainty, increases diagnosis accuracy, and improves the treatment of patients presenting to the emergency department with undifferentiated hypotension secondary to a tamponade. The following narrative review describes how the literature supports the use of point-of-care ultrasound as a major adjunct of clinical examination, diagnosis, and treatment for patients presenting in shock due to cardiac tamponade using different point-of-care ultrasound protocols. When used by trained physicians, we believe that point-of-care ultrasound should be part of every protocol for the management of shocked patients in emergency departments.

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Patient consent available in French. Translation can be obtained if necessary.

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References

  1. American College of Emergency Physicians. ACEP emergency ultrasound guidelines-2001. Ann Emerg Med. 2001;38(4):470–81.

  2. Moore C, Copel J. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–57.

    Article  CAS  Google Scholar 

  3. Filly R. Is It Time for the Sonoscope? If So, Then Lets Do It Right. J Ultrasound Med. 2003;2003(22):323–5.

    Article  Google Scholar 

  4. Ultrasound guidelines: emergency, point-of-care and clinical ultrasound guidelines in medicine, 2017. Ann Emerg Med. 2017;69:27–54.

  5. Rempell JS, et al. Pilot Point-of-care ultrasound curriculum at Harvard medical school: early experience. West J of Emerg Med. 2016;17:734–40. https://doi.org/10.5811/westjem.2016.8.31387.

    Article  Google Scholar 

  6. Bobbia X, Claret P-G, Perrin-Bayard R, de La Coussaye J-E. Place of point-of-care ultrasound in emergency medicine. Ann Fr Med Urgence. 2020;10:31–7.

    Article  Google Scholar 

  7. Volpicelli G, Lamorte A, Tullio M, Cardinale L, Giraudo M, Stefanone V, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med. 2013;39:1290–8.

    Article  CAS  Google Scholar 

  8. Sebat F, Johnson D, Musthafa A, Watnik M, Moore S, Henry K, et al. A multidisciplinary community hospital program for early and rapid resuscitation of shock in nontrauma patients. Chest. 2005;127:1729–43.

    Article  Google Scholar 

  9. Jones A, Craddock P, Tayal V, Kline J. Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Shock. 2005;24:513–7.

    Article  Google Scholar 

  10. Jones A, Tayal V, Sullivan D, Kline J. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004;32:1703–8.

    Article  Google Scholar 

  11. Shokoohi H, Boniface K, Pourmand A, Liu Y, Davison D, Hawkins K, et al. Bedside ultrasound reduces diagnostic uncertainty and guides resuscitation in patients with undifferentiated hypotension. Crit Care Med. 2015;43:2562–9.

    Article  Google Scholar 

  12. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: rapid ultrasound in shock in the evaluation of the critically ill. Emerg Med Clin North Am. 2010;28:29–56.

    Article  Google Scholar 

  13. Hrymak C, Weldon E, Pham C. The educational impact of a formalized RUSH (Rapid Ultrasound in Shock) protocol in emergency medicine residency ultrasound training. CJEM. 2016;18:61–2.

    Google Scholar 

  14. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH Exam 2012: rapid ultrasound in shock in the evaluation of the critically ill patient. Ultrasound Clinics. 2012;7:255–78.

    Article  Google Scholar 

  15. Atkinson P, Bowra J, Milne J, Lewis D, Lambert M, Jarman B, et al. International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest. CJEM. 2016;19:459–70.

    Article  Google Scholar 

  16. Atkinson P, McAuley D, Kendall R, Abeyakoon O, Reid C, Connolly J, Lewis D. Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. EMJ. 2009;26:87–91.

    Article  CAS  Google Scholar 

  17. Hatch N, Wu T. Advanced Ultrasound Procedures. Crit Care Clin. 2014;30:305–29.

    Article  Google Scholar 

  18. Backer D. Hemodynamic monitoring using echocardiography in the critically ill. Berlin: Springer; 2011. p. 13–4.

    Book  Google Scholar 

  19. Connolly J, Dean A, Hoffmann B, Jarman R. Emergency point-of-care ultrasound. Chichester: John Wiley & Sons; 2011. p. 359–60.

    Google Scholar 

  20. Perera P, Mandavia D, Goodman A, Mailhot T. The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade. J Emerg Trauma Shock. 2012;5:72.

    Article  Google Scholar 

  21. Noble V, Nelson B. Manual of Emergency and Critical Care Ultrasound. Cambridge: Cambridge University Press; 2014. p. 78–80.

    Google Scholar 

  22. Pishe T, Ross P, Atkinson P. My patient has no blood pressure: is their heart working? Ultrasound. 2012;20:58–63.

    Article  Google Scholar 

  23. Atkinson P, Daly C. My patient has no blood pressure: are they empty or full? Point-of-care ultrasound of the inferior vena cava in the hypotensive emergency department patient. Ultrasound. 2011;19:169–73.

    Article  Google Scholar 

  24. Breunig M, Kashiwagi D. Using point-of-care ultrasound. J Am Acad Phys Assist. 2019;32:43–8.

    Google Scholar 

  25. Stickles S, Carpenter C, Gekle R, Kraus C, Scoville C, Theodoro D, et al. The diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology: A systematic review and meta-analysis. CJEM. 2019;21:406–17.

    Article  Google Scholar 

  26. Sebat F, Musthafa A, Johnson D, Kramer A, Shoffner D, Eliason, et al. Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years. Crit Care Med. 2007;35:2568–75.

    Article  Google Scholar 

  27. Privette A, Dicker R. Recognition of hypovolemic shock: using base deficit to think outside of the ATLS box. Crit Care. 2013:17124.

  28. Liteplo A, Noble V, Atkinson P. My patient has no blood pressure: point-of-care ultrasound in the hypotensive patient – FAST and RELIABLE. Ultrasound. 2012;20:64–8.

    Article  Google Scholar 

  29. Umbjournal.org. (2018). [online] Available at: http://www.umbjournal.org/article/S0301-5629(17)31662-9/pdf [Accessed 15 Mar. 2020].

  30. Sinnaeve P, Adriaenssens T. A contemporary look at pericardiocentesis. Trends Cardiovasc Med. 2019;29:375–83.

    Article  CAS  Google Scholar 

  31. Tsang T, Enriquez-Sarano M, Freeman W, Barnes M, Sinak L, Gersh B, et al. Consecutive 1127 Therapeutic Echocardiographically Guided Pericardiocenteses: Clinical Profile, Practice Patterns, and Outcomes Spanning 21 Years. Mayo Clin Proc. 2002;77:429–36.

    Article  Google Scholar 

  32. Soucy ZP, Mills LD. American Academy of Emergency Medicine Position Statement: ultrasound should be integrated into undergraduate medical education curriculum. J Emerg Med juill. 2015;49(1):89–90.

    Article  Google Scholar 

  33. Cantisani V, Dietrich C, Badea R, Dudea S, Prosch H, Cerezo E, et al. EFSUMB statement on medical student education in ultrasound [long version]. Ultrasound Int Open. 2016;02(01):E2‑7.

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Acknowledgements

Simon Richard, Senior ultrasound lecturer, University of Teesside, United Kingdom

Robert Jarman, MD, consultant in Emergency Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom

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Authors and Affiliations

  1. Emergency Department, Cliniques Universitaires Saint Luc, Brussels, Belgium

    Valérie de Visscher, Gauthier Moureau & Florence Dupriez

  2. Emergency Department, Centre Hospitalier de Jolimont, Lobbes, Belgium

    Félix Gendebien

Authors
  1. Valérie de Visscher
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  2. Gauthier Moureau
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  3. Félix Gendebien
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  4. Florence Dupriez
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Contributions

Valérie de Visscher: literature review and draft of the manuscript.

Gauthier Moureau: critical revision of the manuscript.

Félix Gendebien: critical revision of the manuscript.

Florence Dupriez: literature review, conception, and critical revision of the manuscript.

Corresponding author

Correspondence to Florence Dupriez.

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Patient consent form for publication was obtained in French.

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Patient gave written consent in French for publication.

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The authors declare no competing interests.

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Appendix 1

Appendix 1

Search strings

“Emergency”[All Fields] AND “ultrasound”[All Fields] AND “protocol”[All Fields]) OR “algorithm”[All Fields]) AND “tamponade”[All Fields] AND “shock”[All Fields]) OR “undifferentiated hypotension”[All Fields].

“Emergency”[All Fields] AND “ultrasound”[All Fields] AND “tamponade”[All Fields] AND “treatment”[All Fields].

MESH terms

Emergency medical services [MESH].

Point-of-care testing [MESH].

Ultrasonography [MESH].

Cardiac tamponade [MESH].

Pericardial effusion [MESH].

Free text words

Tamponade, pericardial effusion, emergency ultrasound, emergency patients, emergency department, point of care ultrasound, bedside ultrasound, clinical ultrasound, shock, undifferentiated hypotension, protocol, algorithm diagnosis, treatment.

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de Visscher, V., Moureau, G., Gendebien, F. et al. Point of Care Ultrasound Shock Protocols for Patients’ Bedside Assessment, Diagnosis, and Treatment of Tamponade: a Case Report and Literature Review. SN Compr. Clin. Med. 4, 120 (2022). https://doi.org/10.1007/s42399-022-01197-y

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