Echocardiography in management of the shocked patient

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The use of ultrasound has moved to centre stage in the management of haemodynamically unstable patient. The ability to apply rapidly, the mobility of devices, and bedside delivery are amongst the advantages in using it. In particular, the widespread application of echocardiography has greatly changed the way in which shocked patients are diagnosed and treated. Most importantly is the ability for the clinician to rapidly identify the type of underlying shock, identify pathophysiology that requires immediate treatment and then to clearly outline the need for further imaging or other diagnostic tests. The great majority of patients fall into either one of the following four shock categories, or not infrequently, experience a combination of these. The physician dealing with critically ill patients may have only attained skills in basic echocardiography such as with performing RACE (Rapid Assessment by Cardiac Echo) which is generally adequate in many patients. However an increasing number of clinicians now have advanced skills using a combination of Doppler techniques in addition to newer techniques such as strain or 3 D. These skills add to the diagnostic repertoire. The chart below is a guide to the evaluation in determining the type of shock in a deteriorating patient.