تأثیر التراسونوگرافی بالینی متمرکز روی بیماران با فشار خون پایین بر تصمیم گیری بالینی پزشکان اورژانس Effect of Focused Bedside Ultrasonography in Hypotensive Patients on the Clinical Decision of Emergency Physicians

1. Introduction Shock is a condition of acute circulator failure that leads to decreased organ perfusion due to insufficient oxygen supply to the tissues [1]. The effects of oxygen insufficiency are initially reversible; however, they may quickly become irreversible. As shock progresses, it results in consecutive cell death, target organ damage, multiple organ failure, and death [2]. Today, emergency departments are the places where patients with poor overall condition and critical patients access healthcare services. Majority of these critical patients have shock and hypotension of unknown cause. Diagnostic procedures and treatment have to be performed simultaneously during the medical care of these critical patients at the emergency department. If the diagnostic tests to be used to evaluate these patients are cheap, fast, and applicable at bedside, this will facilitate the work of the clinicians who race against time. One of the diagnostic tests is the use of point of care ultrasound (POCUS) that has been used by emergency medicine specialists for decades especially for traumatic patients and recently applied to critical patients as well. POCUS is getting more important in emergency medicine practices since it is reliable, rapid, noninvasive, and applicable at bedside [3]. Mortality rates in shock patients vary depending on the cause. While mortality due to septic shock is 40%–60%, mortality due to cardiogenic shock ranges between 36% and 56% [4]. It is very important to establish the diagnosis accurately and start the treatment early before organ dysfunction develops in order to reduce the morbidity and mortality in patients with shock. The definitive diagnosis of shock can be established early at the emergency department only in 25% to 50% of the cases [5, 6]. The accuracy of the diagnosis rises up to 80% with the use of POCUS performed in emergency department protocol [6]. The most important goal for the clinician is to determine the etiology of the current condition and avoid any delays in the supportive therapy. Several resuscitation protocols in which ultrasound is used at an early stage for the care of critical patients have been developed recently [7–13].