I just finished preparing an introductory talk on shock & ultrasound. Ultrasound in shock in 50 minutes! After having struggled considerably with the breadth of the topic, i struggled even more with the summary. How does one sum up such a huge topic? In the end, I decided to go with a picture (we all know the saying). Learning theories suggest that in order for a person to learn something new, that new item must first be linked to the individual’s previous knowledge. I borrowed from Weil and Shubin’s (1971) shock classification throughout the slides as I figured it was a good place to start.
This poster hopefully illustrates the usefulness of clinician performed u/s in the assessment of shock. There are nearly as many exceptions to the poster as there are exceptions in the English language!
Here it is, label free (click to expand). Anyone interested in the time-honored medical tradition of “Guess what I’m thinking?”
About that disclaimer… obviously there are exceptions to the above, all of them being clinical realities. RV strain can represent chronic disease, as can LV failure, B Blockers can suppress tachycardia, localized lung rockets may suggest other disease (ie. Pneumonia) and so on.
But all of that said, for some the poster may serve as a good illustration of just how applicable and useful bedside u/s can be for just this ONE indication alone. It combines many of the scan protocols out there (ACES, RUSH, eFAST) but presents ED U/S from a perspective already familiar to practicing emergency physicians (anchoring new learning to previous knowledge). It also lends itself for use with medical students as they try to get their heads around the assessment of shock.
Here it is with labels (click to expand):
I am going to road test it this week. Participants will receive it as a handout at the end of the session. Maybe it will resonate with the trainees, maybe it won’t. In the meantime, I welcome suggestions on how to improve or modify the picture of u/s in shock. Dissenting opinions are equally welcome. Feel free to use it, modify it, or expand on the concept… perhaps a picture of Chest Pain or Dyspnea?
Final disclaimer: The icon images herein are not mine, they have been copied from the internet. Attached below are their respective sources.
Paul Olszynski, MD, CCFP (EM)
Peer reviewed by Nadim Lalani or ERMentor