Hypotension| Shock in Adults

Focused cardiac ultrasound (FoCUS) for a patient that is hypotensive patient is an extension from its use in cardiac arrest. When the cause of shock or hypotension is not evident or undifferentiated, the advantage of FoCUS is in determining whether the shock is cardiogenic.  

The FoCUS interrogation should evaluate for:

1.  Pericardial effusion and presence of tamponade features.
2. Global cardiac function:
- Identification of poor but detectable LV systolic function indicates the need for further inotropes or mechanical support.
- Determine if transcutanous or transvenous pacing is capturing as expected.
- A hyperdynamic LV points out to hypovolemia or suggests sepsis. 
3. Right ventricular size, Mc Connell's sign and clot in transit features to determine the likelihood of massive pulmonary embolism since these are considered specific signs although no sign is sensitive enough to rule it out. 
4. IVC size/collapsibility as a marker of central venous pressure and so is fluid responsiveness.





Follow the following links for a comprehensive evaluation of FoCUS on patients with shock and hypotension.

Shock and hypotension

References

1. Jonathan A. Paul, Oliver P. F. Panzer; Point-of-care Ultrasound in Cardiac Arrest. Anesthesiology 2021; 135:508–519 doi: https://doi.org/10.1097/ALN.0000000000003811

2. Merchant R and all. Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation. 2020;142:S337–S357.  https://doi.org/10.1161/CIR.0000000000000918

3. Berg KM and all. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020;142:S92–S139. https://doi.org/10.1161/CIR.0000000000000893

4. Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K: Focused cardiac ultrasound in the emergent setting: A consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010; 23:1225–30