Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

Area of Science:

• Emergency Medicine
• Critical Care
• Point-of-Care Ultrasound (POCUS)

Background:

• Hemodynamic instability in acutely ill patients necessitates rapid clinical decision-making.
• Point-of-care ultrasound (POCUS) is valuable for augmenting clinical judgment in critical care settings.
• Existing POCUS protocols must be brief yet comprehensive for bedside use.

Purpose of the Study:

• To demonstrate a focused ultrasound protocol for assessing cardiovascular and respiratory systems in unstable patients.
• To introduce the Echocardiographic Assessment using Subxiphoid-Only - Mean Arterial Pressure (EASy MAP) exam.
• To provide a feasible bedside tool for clinicians managing critically ill patients.

Main Methods:

• The EASy MAP exam utilizes a subcostal window for cardiac and inferior vena cava (IVC) views.
• Respiratory assessment includes anterior upper lung and posterolateral diaphragmatic pleural views.
• A low-frequency phased array transducer is used to obtain all six views.

Main Results:

• The protocol provides essential cardiovascular and respiratory information at the bedside.
• Common pitfalls and basic interpretation of findings are discussed.
• A 12-point scale for cardiac view image quality is presented.

Conclusions:

• The EASy MAP exam offers a concise and effective POCUS protocol for hemodynamic assessment.
• This focused ultrasound approach can aid timely clinical decisions in unstable patients.
• The protocol includes image quality assessment and considerations for supplementary views.