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

Lookup NU author(s): James Connolly

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Abstract

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.

Publication metadata

Author(s): Atkinson PRT, McAuley DJ, Kendall RJ, Abeyakoon O, Reid CG, Connolly J, Lewis D

Publication type: Article

Publication status: Published

Journal: Emergency Medicine Journal

Year: 2009

Volume: 26

Issue: 2

Pages: 87-91

Date deposited: 24/05/2010

ISSN (print):

ISSN (electronic): 1472-0213

Publisher: BMJ Group

URL: http://dx.doi.org/10.1136/emj.2007.056242

DOI: 10.1136/emj.2007.056242

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