الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Shock is a life threatening condition in which there is insufficient oxygen delivery to tissues to meet metabolic demand. Early diagnosis and appropriate management aimed at prevention of prolonged hypoperfusion has shown to decrease morbidity and mortality. However, there is often a challenge in emergency department (ED) depending mainly on clinical signs and standard monitoring parameters. The first ultrasound protocol for undifferentiated hypotension was published on 2001 and subsequently more than 15 protocols were proposed.
There is significant overlap of clinical findings in different types of shock and on the other hand laboratory investigations are time consuming. This is even more challenging in critically ill patients. To overcome this, point of care protocols integrate focused cardiac examination, inferior vena cava (IVC), aorta and lung ultrasound to assist diagnosis. The goal is to find a systematic way to classify the non-specific clinical syndrome into more specific types of shock. Almost all studies of ultrasound in shock assess the Rapid Ultrasound in Shock (RUSH) protocol with a common finding: lowest agreement, sensitivity, specificity and accuracy were for distributive shocks. Moreover, RUSH exam could not differentiate between hypovolemic shock and early septic shock. We utilized Left Ventricular Out flow Tract Velocity Time Integral (LVOT VTI) as surrogate for stroke volume and cardiac output to differentiate distributive from other types of shock as it is low in all types of shock except distributive. We combined ultrasound findings of pneumonia to increase the diagnostic accuracy. All studies regarding the use of ultrasound in shock relied on reduced left ventricular function to diagnose cardiogenic shock, with no attention to other etiologies such as valvular pathologies or mechanical complications of myocardial infarction.