Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. Issue 2 (22nd January 2009)

• Record Type: Journal Article
• Authors: Atkinson, P R T; McAuley, D J; Kendall, R J; Abeyakoon, O; Reid, C G; Connolly, J; Lewis, D
• Is Part Of: Emergency medicine journal. Volume 26:Issue 2(2009)
• Page Start: 87
• Page End: 91
• Publication Date: 2009-01-22
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emj.2007.056242
• Languages: English
• ISSNs: 1472-0205

Abstract

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.