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Emerg Med J. 2009 Feb;26(2):87-91. doi: 10.1136/emj.2007.056242.

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

Author information

1
Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK. paul.atkinson@addenbrookes.nhs.uk

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.

PMID:
19164614
DOI:
10.1136/emj.2007.056242
[Indexed for MEDLINE]

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