There is perhaps no greater challenge to the emergency and critical care physician than management of the hypotensive patient. A rapid, yet accurate, assessment is essential in this clinical setting. Point-of-care ultrasound (PoCUS) has evolved to become an indispensable test in the critical care and emergency setting. This article addresses the use of ultrasound in the evaluation of the hypotensive patient and reviews some of the scanning protocols and algorithms that have been described. We use the mnemonic FAST and RELIABLE to describe key aspects of PoCUS for undifferentiated hypotension.
SloanJ, JarmanB. My patient has no blood pressure: introducing the FAST scan. PoCUS series. Ultrasound2011;19:164–8
2.
GrimbergA, ShigueokaDC, AtallahAN, AjzenS, IaredW. Diagnostic Accuracy of sonography for pleural effusion: systematic review. Sao Paulo Med J2010;128:90–5
3.
PisheT, RossP, AtkinsonP. My patient has no blood pressure: is their heart working? POCUS series. Ultrasound2012;20:58–63
4.
MooreCL, RoseGA, TayalVS, SullivanDM, ArrowoodJA, KlineJA. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med2002;9:186–93
5.
JonesAE, CraddockPA, TayalVS, KlineJA. Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Shock2005;24:513–7
6.
AtkinsonP, DalyC. 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. Ultrasound2011;19:169–73
7.
GedmintasA, GraboveM, AtkinsonP. My patient has no blood pressure: have they got an abdominal aortic aneurysm? POCUS series. Ultrasound2011;19:236–41
8.
CrispJG, LovatoLM, JangTB. Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department. Ann Emerg Med2010;56:601–10
9.
BlaivasM, LyonM, DuggalS. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med2005;12:844–9
10.
SteinJC, WangR, AdlerN, Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. Ann Emerg Med2010;56:674–83
11.
RoseJS, BairAE, MandaviaD, KinserDJ. The UHP ultrasound protocol: a novel ultrasound approach to the empiric evaluation of the undifferentiated hypotensive patient. Am J Emerg Med2001;19: 299–302
12.
JonesAE, TayalVS, SullivanDM, KlineJA. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med2004;32:1703–8
13.
HernandezC, ShulerK, HannanH, SonyikaC, LikourezosA, MarshallJ. C.A.U.S.E.: cardiac arrest ultra-sound exam – a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation2008;76:198–206
14.
AtkinsonPR, McAuleyDJ, KendallRJ, Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. Emerg Med J2009;26:87–91
15.
PereraP, MailhotT, RileyD, MandaviaD. The RUSH exam: Rapid Ultrasound in Shock in the evaluation of the critically lll. Emerg Med Clin North Am2010;28:29–56
