Protocol and reference methods notes c circulation

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Protocol and reference Methods Notes C – Circulation (cardiac, IVC, FAST, aorta, DVT) D – Disability (optic nerve, cranial ultrasound) E – Exposure (extremities) 266 Diagnostic ultrasound Ultrasound in shock
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12. Jones AE, Tayal VS, Sullivan DM, Kline JA. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med 2004; 32 : 1703–8. 13. Breitkreutz R, Walcher F, Seeger FH. Focused echocardiographic evalu- ation in resuscitation management: concept of an advanced life support- conformed algorithm. Crit Care Med 2007; 35 : S150–61. 14. Hernandez C, Shuler K, Hannan H, et al. C.A.U.S.E.: Cardiac arrest ultra- sound exam. A better approach to managing patients in primary non- arrhythmogenic cardiac arrest. Resuscitation 2008; 76 : 198–206. 15. Weingart SD, Duque D, Nelson BP. The RUSH exam: rapid ultra- sound for shock/hypotension. text.emcrit.org/ultrasound/The%20RUSH %20Examfinal.htm. 16. Atkinson PR, McAuley DJ, Kendall RJ, et al. Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emer- gency physicians for the use of ultrasound in patients with undifferen- tiated hypotension. Emerg Med J 2009; 26 : 87–91. 17. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically ill. Emerg Med Clin North Am 2010; 28 : 29–56, vii. 18. Neri L, Storti E, Lichtenstein D. Toward an ultrasound curriculum for critical care medicine. Crit Care Med 2007; 35 : S290–304. Diagnostic ultrasound 267 Ultrasound in shock
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Section 2 Procedural ultrasound 15 Vascular access 273 16 Ultrasound for procedure guidance 297
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Performing procedures on acutely ill patients can be one of the most rewarding and challenging aspects of emergency medicine and critical care practice. These patients present unique challenges to the clinician for a variety of reasons. Most notably, since they are acutely ill or decompensating, there is an urgency to perform procedures in suboptimal conditions. The patients themselves often pose unique challenges. Many patients have abnor- mal anatomy due to prior surgical procedures, scarring, trauma, or acute or chronic illness. In addition, obesity can obscure standard anatomic land- marks. Perhaps the clinician attempting to perform the procedure will not be the first operator or must navigate through a prior failed procedural attempt. Finally, because of the acuity of their illness, many patients do not have the functional capacity to remain in standard procedural positions (i.e., lying in the Trendelenburg position or sitting upright), and this often makes successful procedural outcomes more challenging. These conditions are found in many critical care settings – therefore, the benefits of ultrasound guidance for procedures are not limited to the emergency department.
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