Echocardiography in shock management

نویسنده

  • Anthony S. McLean
چکیده

Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography. A more comprehensive diagnosis can be achieved with advanced levels of competency, for which practice guidelines are also now available. Hemodynamic evaluation and ongoing monitoring are possible with advanced levels of competency, which includes the use of colour Doppler, spectral Doppler, and tissue Doppler imaging and occasionally the use of more recent technological advances such as 3D or speckled tracking.The four core types of shock-cardiogenic, hypovolemic, obstructive, and vasoplegic-can readily be identified by echocardiography. Even within each of the main headings contained in the shock classification, a variety of pathologies may be the cause and echocardiography will differentiate which of these is responsible. Increasingly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock or hypovolemia and ventricular outflow obstruction.The diagnostic benefit of echocardiography in the shocked patient is obvious. The increasing prevalence of critical care physicians experienced in advanced techniques means echocardiography often supplants the need for more invasive hemodynamic assessment and monitoring in shock.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Commentary: Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock

Shock in newborn infants has unique etiopathologic origins that require careful assessment to direct specific interventions. Early diagnosis is key to successful management. Unlike adults and pediatric patients, shock in newborn infants is often recognized in the uncompensated phase by the presence of hypotension, which may be too late. The routine methods of evaluation used in the adult and pe...

متن کامل

Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes.

PURPOSE The purpose of the study was to compare the effect of limited echocardiography (LE)-guided therapy to standard management on 28-day mortality, intravenous fluid prescription, and inotropic dosing following early resuscitation for shock. MATERIALS AND METHODS Two hundred twenty critically ill patients with undifferentiated shock from a quaternary intensive care unit were included in th...

متن کامل

Transesophageal guided left atrial positioning of a percutaneous ventricular assist device.

Cardiogenic shock in the setting of myocardial infarction continues to represent a high proportion of immediate mortality in this patient population, despite ongoing advances in thrombolytics, PCI, and medical management of AMI. We present a case of peri-MI cardiogenic shock necessitating deployment of a percutaneous ventricular assist device (pVAD). TEE guidance played a crucial role in optima...

متن کامل

3D transesophageal echocardiography is a decision-making tool for the management of cardiogenic shock following a large postinfarction ventricular defect

Postinfarction ventricular septal defect (PIVSD) is a devastating mechanical complication following acute myocardial infarction. The management of this pathology is quite challenging, especially in case of complicated cardiogenic shock. The difficulties lie in the timing and type of intervention. Debates exist with regard to immediate versus deferring repair, as well as open repair versus percu...

متن کامل

Statement on the Role of Echocardiography in Intensive Care Medicine

Critical Care Echocardiography (CCE) was introduced into intensive care medicine practice several decades ago and is now established as a mainstream technique. It is widely used for the diagnosis, monitoring and management of the critically ill patient. Evolving experience and research in CCE has justified its role in the diagnosis of undifferentiated shock, management of the difficult post car...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 20  شماره 

صفحات  -

تاریخ انتشار 2016