Modified Rapid Ultrasound for a Shock Patient

Clinical evaluation of a patient with undifferentiated shock is challenging without the bedside clinical utility of point-of-care ultrasound (POCUS). Scenarios can become complicated when a patient becomes non-transferrable in the critical care unit. POCUS can aid physicians in diagnosing and implementing early management. The retroperitoneal space can accommodate significant bleeding before it becomes apparent. The retroperitoneal space is not included in the POCUS protocol for patients in shock.

We present a case of the history of ischemic cardiomyopathy and atrial fibrillation on apixaban. The patient developed hypotension and severe anaemia. The cause of shock was unclear clinically until POCUS showed a retroperitoneal hematoma. In this shock patient the hematoma was detected by a modified rapid ultrasound that added examination of the retroperitoneal space.

The retroperitoneal space is highly vascular and liable to bleed in patients on antiplatelet and anticoagulation. Including the space in the standard POCUS protocols for shock enables visualization of the retroperitoneal compartment and enhances the ability to detect hidden fluid accumulations.

A modified POCUS protocol, including the retroperitoneal space, for a patient with unexplained haemorrhagic shock, can help in early detection of the site of haemorrhage.

The retroperitoneal space can hold a significant amount of blood before it becomes clinically apparent.Including the retroperitoneal space in the Rapid-Ultrasound for Shock and Hypotension protocol can help in early detection of the site of haemorrhage in a patient with unexplained haemorrhagic shock.