Nalan KOZACI, Ayça AÇIKALIN, Salim SATAR, Sema PÜSKÜLLÜOĞLU, Alim ÇÖKÜK, Adnan KUVVETLİ

Acil Serviste Nontravmatik Şok: ACES (Abdominal and Cardiac Evaluation with Sonography in Shock) Protokolü

Hipotansiyon ve şok acil servis hekimlerinin sık karşılaştığı hayatı tehdit eden durumlardır. Doğru tanı ve hedefe yönelik tedavi sağkalım için şarttır. Acil servislerde travma olgularında yatak başı ultrasonografi ile FAST (Focused assessment with sonography for trauma) bakısı hızlı tanı ve tedavide vazgeçilmez bir uygulamadır. Son yıllarda kullanılan ACES (Abdominal and Cardiac Evaluation with Sonography in Shock) protokolü ise nontravmatik hipotansiyon ve şok tespit edilen hastalarda yaşam kurtarıcı bir protokoldür. Biz bu yazımızda, acil tıp kliniğine başvuran nontravmatik hipotansiyonu ve şoku olan ve intraabdominal hemoraji tanısı konulan dört vakada ACES protokolünün önemini vurgulamayı amaçladık.

Anahtar Kelimeler:

Şok, acil USG, batın içi kanama

Non-traumatic Shock in the Emergency Department: The ACES (Abdominal and Cardiac Evaluation with Sonography in Shock) Protocol

Hypotension and shock are life-threatening situations that emergency physicians encounter frequently. The correct diagnosis and targeted therapy are essential for survival. Evaluating trauma cases with FAST (Focused Assessment with Sonography for Trauma) in cases of trauma is an indispensable application for rapid diagnosis and treatment in the emergency department. In recent years, the ACES protocol (Abdominal and Cardiac Evaluation with Sonography in Shock) has been a life-saving protocol in patients with nontraumatic hypotension and shock. In this paper, we aimed to emphasize the importance of the ACES protocol in four cases admitted to the emergency department with non-traumatic hypotension and shock, diagnosed as massive intra-abdominal hemorrhage

Keywords:

Shock, emergency US, intra-abdominal hemorrhage,

PDF

___

Atkinson PR, McAuley DJ, Kendall RJ, Abeyakoon O, Reid CG, Connolly J, Lewis D. Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. Emerg Med J 2009; 26: 87-91. [CrossRef]
Rose JS, Bair AE, Mandavia D. The UHP ultrasound protocol: a novel ultrasound approach to the empiric evaluation of the undifferentiated hypotensive patient. Am J Emerg Med 2001; 19: 299-302. [CrossRef]
Jones AE, Tayal VS, Sullivan DM, Kline JA. Randomized controlled trial of immediate versus delayed goal-directed ultrasound to identify the ca- use of nontraumatic hypotension in emergency department patients. Crit Care Med 2004; 32: 1703-8. [CrossRef]
Perera Pp, Mailhot T, Riley D, Mandavia D. The RUSH Exam: Rapid Ult- rasound in Shock in the Evaluation of the Critically lll. Emerg Med Clin North Am 2010; 28: 29-56. [CrossRef]
Weekes AJ, Zapata RJ, Napolitano A. Symptomatic Hypotension: ED sta- bilization and the emerging role of sonography. Emergency Medicine Practice 2007; 9: 1-28.
Furlan A, Fakhran S, Federle MP. Spontaneous abdominal hemorrhage: causes, CT findings, and clinical implications. AJR Am J Roentgenol 2009; 193: 1077-87. [CrossRef]
Lucey BC, Varghese JC, Soto JA. Spontaneous hemoperitoneum: Causes and significance. Curr Probl Diagn Radiol 2005; 34: 182-95. [CrossRef]
Laviolette E. Need for bedside emergency department ultrasonog- raphy: Case report of a ruptured ectopic pregnancy. CJEM 2004;6:112-5.
Kasum M. Hemoperitoneum caused by a bleeding myoma in preg- nancy. Acta Clin Croat 2010;49:197-200.
Hassani KI, Bounekar A, Gruss JM. Spontaneous rupture of the right gastroepiploic artery: Unusual cause of acute abdomen and shock. World World J Emerg Surg 2009; 4: 24. [CrossRef]
Kar H, Peker Y, Cin N, Kahya M C, Koç O, Karabuğa T, et al. Intra-abdo- mınal hemorrhage due to uncontrolled warfarin therapy: Two case re- ports. Marmara Medical Journal 2010; 23; 377-81.