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Related Concept Videos

Assessing Blood pressure using a doppler ultrasound01:19

Assessing Blood pressure using a doppler ultrasound

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To obtain accurate blood pressure measurements in clinical settings, especially when traditional methods are insufficient, healthcare professionals utilize the Doppler ultrasound technique. This method uses high-frequency sound waves to detect blood flow within the arteries, which is crucial for patients with conditions that complicate circulatory system assessment.
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Ultrasonography01:17

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Ultrasonography is an imaging technique that uses high-frequency sound waves to visualize the body's internal structures. It is a non-invasive and safe procedure that does not involve the use of ionizing radiation, making it widely used in various medical fields. Ultrasonography is used to study heart function, blood flow in the neck or extremities, certain conditions such as gallbladder disease, and fetal growth and development.
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Updated: Jan 16, 2026

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
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Modified Rapid Ultrasound for a Shock Patient.

Zouheir Ibrahim Bitar1, Saifaldin Ahmed2, Meshaal Alkandery3

  • 1Critical Care Unit, Ahmadi Hospital, Kuwait Oil Comoany, Ahmadi, Kuwait.

European Journal of Case Reports in Internal Medicine
|January 15, 2026
PubMed
Summary
This summary is machine-generated.

Point-of-care ultrasound (POCUS) can be challenging in undifferentiated shock. A modified POCUS protocol including the retroperitoneal space aids in early detection of hidden hemorrhage, especially in patients on anticoagulation.

Keywords:
Retroperitoneal spacemodified RUSH protocolshock

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Area of Science:

  • Emergency Medicine
  • Critical Care
  • Diagnostic Imaging

Background:

  • Undifferentiated shock poses diagnostic challenges, particularly in non-transferable critical care patients.
  • Point-of-care ultrasound (POCUS) is a valuable bedside tool for diagnosis and management.
  • The retroperitoneal space, capable of significant hidden bleeding, is often excluded from standard shock POCUS protocols.

Purpose of the Study:

  • To highlight the utility of a modified POCUS protocol in diagnosing retroperitoneal hematoma in a patient with undifferentiated shock.
  • To emphasize the importance of including the retroperitoneal space in shock POCUS evaluations.

Main Methods:

  • Case presentation of a patient with ischemic cardiomyopathy and atrial fibrillation on apixaban who developed hypotension and anemia.
  • Application of a modified rapid ultrasound for shock protocol that included examination of the retroperitoneal space.
  • Clinical correlation of POCUS findings with patient presentation.

Main Results:

  • POCUS revealed a significant retroperitoneal hematoma as the cause of the patient's unclear shock.
  • The modified protocol successfully identified bleeding in a compartment not typically assessed in shock evaluations.
  • Early detection facilitated timely management.

Conclusions:

  • The retroperitoneal space can conceal substantial hemorrhage, leading to apparent undifferentiated shock.
  • Integrating retroperitoneal assessment into the Rapid-Ultrasound for Shock and Hypotension (RUSH) protocol enhances diagnostic capabilities.
  • This modified approach aids in the early detection and management of unexplained hemorrhagic shock.