Phân loại và quản lý sốc: Đặt những thông số của bạn cùng nhau Ken Lyn-Kew – National Jewish, Denver, CO

• Is a key component of an initial (and ongoing) evaluation of a patient in shock (or respiratory failure) - especially if unclear etiology. Goal Directed Echocardiography (GDE) Goal D[r]

Ken Lyn-Kew – National Jewish, Denver, CO

Categorization and Management of Shock: Putting Together Your Exams

How Do We Teach Ultrasound?

• The general way point of care ultrasound is taught is to exam an organ or set of organs

– Eg: Lung exam

• This is good for putting together a class or course

• We use ultrasound to answer questions

– Why is this person in shock?

– Why is this patient short of breath?

Whole Body Ultrasound

• Idea that putting together the different exams allows you to answer your question

– Why is this patient dyspneic?

• Lung US + Cardiac US + DVT exam

Putting things together

• Basic echo findings (size, function, etc)

• Qualitative

• Designed to answer specific questions

• Repeatable

• Can be performed in a few minutes

• Is a key component of an initial (and ongoing)

evaluation of a patient in shock (or respiratory failure) - especially if unclear etiology

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Goal Directed Echocardiography (GDE)

Goal Directed Ultrasound (GDU)

Dx Resp Failure Etiology?

Blue Protocol

• 260 pts with respiratory failure – had a

diagnosis categorized by US findings alone

compared to ultimate “gold standard” diagnosis

• Correctly categorized Dx in > 90% of cases

• Differentiated asthma/COPD; PE; pneumonia; pulmonary edema; PNTX

Lichtnestein, D Chest 2008; 134: 117

– 139 consecutive pts with acute respiratory failure

– US heart, lungs and deep veins

– 96% could have exam completed

– 14% found condition missed with primary assessment – Using audit as gold standard:

• SN 100%; SP 93.3%; PPV 76.7% and NPV 100%

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Case #1

• Pt presents to the ED via EMS; family

called after not hearing from pt and pt was found breathing but non-

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