Role of Chest Ultrasound in Management of Shocked Patients

Abstract

Background:Care of the patient with shock is one of the most challenging issues in emergency medicine and critical care. Use of thoracic ultrasonography has gained a wider ground in emergency medicine and intensive care. So, lung ultrasound is being a basic application, allowing the assessment of urgent diagnoses and therapeutic decisions. Aim of the work:This Study aimed to assess the value of chest ultrasound in differentiation between different types of shock for proper treatment. Materials and Methods:Our prospective study was conducted on 68 shocked patients, 39 were males(58%)and 29 were females (41%) their age ranged from 20 to 85years with mean age 58 years. All patients were admitted to the Respiratory Intensive Care Unit (RICU) of Chest Department at Assuit University Hospital during the period from November 2016 to April 2017 and were evaluated for the cause of shock.We performed early bed-side chest sonographic examination. Results:68 shocked patients were included in the study. 30 patients were septic shock, 19 patients were obstructive shock, 11 patients were cardiogenic shock,4 patients were hypovolemic shock,2 patients were mixed type of the shock, and 2 patients were not defined the causes of the shock. The study shows that there was a significant relationship between different types of shock and chest ultrasound finding (P= 0.04). 14 cases (46.7%) with septic shock had consolidation.14 cases (46.7%) with septic shock had pleural effusion and it was Para pneumonic. Also, we found 9 cases with pleural effusion (47.3%) in obstructive shock due to pulmonary embolism. We found B-lines in 45.5% in cardiogenic shocked patients. Also, there was a significant relationship between PH and PaCO2 different types of shock (P=0.04& 0.01 respectively). We found that combined respiratory Acidosis and metabolic alkalosis was more in patients with septic shock.Also, we found that patients with cardiogenic shock had both acidosis and alkalosis disorders in equal. Conclusion:We highlight the role of integrating chest ultrasound techniques in the physician resuscitation pathways to diagnose shock etiology, augment their clinical evaluation and guide resuscitation.