PROTOCOLS for SHOCK

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PROTOCOLS FOR SHOCK

Shock is a major morbidity in emergency and critical care and is also one of the important prognostic factors affecting  in-hospital mortality [1]. Timely diagnosis and treatment of shock reduce the length of stay (LOS) and mortality rate at the emergency department (ED). The early use of the point of care ultrasound (POCUS) can reduce the diagnostic time as well as increase the accuracy of diagnosis [2]. The first protocol Undifferentiated hypotension protocol (UHP) was release on 2001, [3]; and more than 15 subsequent protocols were developed [4].

Future and discussion

Most currently available protocols are focused on diagnosis.Blanco et al. suggested that an ultrasound scan should also assess the efficacy of treatment [5]. For example, the use of velocity time integral (VTI) of LVOT to measure the responses to fluid and inotropic agent to help further management.

Point of care ultrasound is a powerful tool in emergency setting. The emergency ultrasound procedures for shock can reduce the LOS at the emergency department.

Therefore, POCUS is an essential skill for personnels in the emergency department and critical care units.

PROTOCOLS for SHOCK

CẮT TÚI MẬT NỘI SOI: TIÊU CHUẨN SIÊU ÂM TIÊN LƯỢNG KHÓ

Abstract

Purpose: Laparoscopic cholecystectomy (LC) has become the treatment of choice for cholelithiasis. Still some patients required conversion to open cholecystectomy (OC). Our aim was to develop a standardized Ultrasound based scoring system for preoperative prediction of difficult LC.

 Methods and materials: Ultrasound findings of 300 patients who underwent LC were reviewed retrospectively. Four parameters (time taken, biliary leakage, duct or arterial injury, and conversion) were analyzed to classify LC as easy or difficult. The following ultrasound findings were analyzed: GB wall thickness, pericholecystic collection, distended GB, impacted stones, multiple stones, CBD diameter and liver size. Out of seven parameters, four were statistically significant in our study. A score of 2 was assigned for the presence of each significant finding and a score of 1 was assigned for the remaining parameters to a total score of 11. A cut-off value of 5 was taken to predict easy and difficult LC.

 Results: 66 out of 83 cases of difficult LC and 199 out of 217 cases of easy LC were correctly predicted on the basis of scoring system. A score of >5 had sensitivity 80.7% and specificity 91.7% for correctly identifying difficult LC. Prediction came true in 78.8% difficult and 92.6% easy cases. US findings of GB wall thickness, distended GB, impacted stones and dilated CBD were found statistically significant.

Conclusion: This indigenous scoring system is effective in predicting conversion risk of LC to OC. Patients having high risk may be informed and scheduled appropriately and decision to convert to OC in case of anticipated difficulty may be taken earlier.

ª 2017, Elsevier Taiwan LLC and the Chinese Taipei Society of Ultrasound in Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).