Point-of-Care Ultrasound in Acute Patients in Obstructive Shock

Abstract

Point-of-care ultrasound (POCUS) is a brief ultrasound
assessment integral to the management of acutely ill patients. Its increasing use stems from its accessibility, speed, and enhanced diagnostic precision, offering prognostic insights and aiding in the clinical progression of unstable patients. POCUS provides real-time diagnosis, relying on a high clinical suspicion without dependence on time-consuming laboratory tests or imaging studies. While not a replacement for complex ultrasound exams by specialists, POCUS serves as the fifth pillar of the physical examination, finding diverse applications in wards, emergency rooms, and both intra- and extra-hospital settings. This case study illustrates the efficacy of POCUS in diagnosing a 55-year-old woman with suspected cardiac tamponade, presenting with hypotension, hyperlactacidemia, and an enlarging cardiothoracic
silhouette on chest X-ray. The Rapid Ultrasound for Shock
and Hypotension (RUSH) protocol revealed a sizable pericardial effusion, prompting emergent transfer to Cardiology for pericardial drainage. This case underscores the critical role of ultrasound skills in managing acute patients and highlights POCUS as an essential component in the evaluation of critically ill patients, complementing traditional history and physical examination.