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LO042: Sonography in Hypotension and Cardiac Arrest (SHoC) - Hypotension: derivation of an evidence-based consensus algorithm for the integration of point of care ultrasound into resuscitation of hypotensive patients

Published online by Cambridge University Press:  02 June 2016

P. Atkinson
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC Dalhousie University, Saint John Regional Hospital, New Brunswick, Toronto, ON
J. Bowra
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC Australasian College for Emergency Physicians, West Melbourne, VC
J. Milne
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
M. Lambert
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
B. Jarman
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
V. Noble
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC American College of Emergency Medicine, Dallas, TX
H. Lamprecht
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
D. Lewis
Affiliation:
Dalhousie University, Saint John Regional Hospital, New Brunswick, Toronto, ON Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
T. Harris
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
R. Gangahar
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
M. Stander
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
C. Muhr
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
J. Connolly
Affiliation:
International Federation for Emergency Medicine, West Melbourne, VC
R. Gaspari
Affiliation:
American College of Emergency Medicine, Dallas, TX
R. Kessler
Affiliation:
American College of Emergency Medicine, Dallas, TX
C. Raio
Affiliation:
American College of Emergency Medicine, Dallas, TX
P. Sierzenski
Affiliation:
American College of Emergency Medicine, Dallas, TX
B. Hoffmann
Affiliation:
American College of Emergency Medicine, Dallas, TX
C. Pham
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
M. Woo
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
P. Olszynski
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
R. Henneberry
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
O. Frenkel
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
J. Chenkin
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
G. Hall
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
L. Rang
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
M. Valois
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
C. Wurster
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
M. Tutschka
Affiliation:
Critical Care/Pediatric Point of Care Ultrasound, Saint John Regional Hospital, New Brunswick, Toronto, ON
R. Arntfield
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON
J. Fischer
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON Critical Care/Pediatric Point of Care Ultrasound, Saint John Regional Hospital, New Brunswick, Toronto, ON
M. Tessaro
Affiliation:
Canadian Association of Emergency Physicians/Canadian Emergency Ultrasound Society Ottawa, ON Critical Care/Pediatric Point of Care Ultrasound, Saint John Regional Hospital, New Brunswick, Toronto, ON

Abstract

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Introduction: Point of care ultrasound has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH, ACES, etc) were developed by expert user opinion, rather than objective, prospective data. We wished to use reported disease incidence to develop an informed approach to PoCUS in hypotension using a “4 F’s” approach: Fluid; Form; Function; Filling. Methods: We summarized the incidence of PoCUS findings from an international multicentre RCT, and using a modified Delphi approach incorporating this data we obtained the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. The modified Delphi tool was developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients. Results: Rates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). After two rounds of the survey, using majority consensus, agreement was reached on a SHoC-hypotension protocol comprising: A. Core: 1. Cardiac views (Sub-xiphoid and parasternal windows for pericardial fluid, cardiac form and ventricular function); 2. Lung views for pleural fluid and B-lines for filling status; and 3. IVC views for filling status; B. Supplementary: Additional cardiac views; and C. Additional views (when indicated) including peritoneal fluid, aorta, pelvic for IUP, and proximal leg veins for DVT. Conclusion: An international consensus process based on prospectively collected disease incidence has led to a proposed SHoC-hypotension PoCUS protocol comprising a stepwise clinical-indication based approach of Core, Supplementary and Additional PoCUS views.

Type
Oral Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2016