Detecting spontaneous retroperitoneal hemorrhage using a modified RUSH protocol: a case report.

Area of Science:

• Emergency Medicine
• Radiology
• Critical Care

Background:

• Retroperitoneal bleeding is a severe complication leading to hypovolemia and shock.
• Standard point-of-care ultrasound (POCUS) protocols for shock assessment often exclude the retroperitoneal space.
• Spontaneous retroperitoneal hematomas are associated with advanced age and dual antiplatelet therapy.

Purpose of the Study:

• To highlight the utility of modified POCUS in diagnosing retroperitoneal bleeding in a patient with shock.
• To advocate for the inclusion of retroperitoneal space examination in POCUS protocols for shocked patients.

Main Methods:

• Case presentation of a 74-year-old male with ischemic heart disease on dual antiplatelet therapy presenting with abdominal pain and shock.
• Modified POCUS examination including the retroperitoneal space to identify the bleeding source.
• Confirmation of bleeding source via abdominal computed tomography (CT).

Main Results:

• Modified POCUS successfully detected a retroperitoneal bleeding source in a patient with unexplained shock.
• The patient, aged 70+ and on dual antiplatelet therapy, was managed conservatively.
• Early diagnosis through POCUS facilitated a clear patient care plan.

Conclusions:

• A modified POCUS protocol incorporating retroperitoneal space examination is valuable for diagnosing unexplained hemorrhagic shock.
• Integrating POCUS into initial shock assessment leads to earlier and more accurate diagnoses.
• Routine inclusion of retroperitoneal assessment in POCUS for shocked patients is recommended.