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J Emerg Trauma Shock. 2019 Jan-Mar;12(1):10-17. doi: 10.4103/JETS.JETS_61_18.

Utility of Point-of-Care Ultrasound in Differentiating Causes of Shock in Resource-Limited Setup.

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Department of Emergency Medicine, Medical College and SSG Hospital, Vadodara, Gujarat, India.
Department of Preventive and Social Medicine, Medical College and SSG Hospital, Vadodara, Gujarat, India.



Delivering early diagnosis of shock in resource-limited setting is challenging, especially with limited availability of point-of-care laboratory and radiological diagnostic facilities. There is growing urgency to provide point-of-care diagnosis and treatment for time-sensitive condition like shock.


We tried to evaluate the application of point-of-care ultrasound (Rapid Ultrasound for Shock and Hypertension [RUSH] protocol) considering different disease cohort and practice realities in our setup.

Settings and Design:

This study was a single-center prospective diagnostic study to check the diagnostic accuracy of point-of-care ultrasound (RUSH protocol). This study was approved by the ethics committee.

Materials and Methods:

The study was conducted at the emergency medicine department of a tertiary care government hospital in Central Gujarat from November 16 to October 17. All adult patients with clinical features of shock with systolic blood pressure <90 mmHg and shock index >1 presenting to emergency department were included as participants. The results of point-of-care ultrasound (RUSH protocol) were compared with the diagnosis given by consultants of respective department as per standard departmental practices.

Statistical Analysis and Results:

A total of 130 patients were enrolled in this study. Mean time taken to examine by the point-of-care Ultrasound (RUSH protocol) was 12 min (range 11-14 min). Kappa index was 0.860. This protocol was able to correctly diagnose 100% of obstructive shock, 96.3% of cardiogenic shock, 94.4% of hypovolemic shock, 80.9% of mixed type of shock, and 75% of distributive type of shock.


This study highlights the role of point-of-care ultrasound (RUSH protocol) for early diagnosis of the shock etiology in emergency medicine department. Diagnosis using point-of-care ultrasound (RUSH protocol) significantly agreed with medical diagnosis. It showed good efficacy of point-of-care ultrasound (RUSH protocol) to differentiate causes of shock with good accuracy except distributive shock.


Emergency medicine; Rapid Ultrasound for Shock and Hypertension protocol; point-of-care ultrasound; shock

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