Point of Care Ultrasound-guided Diamond Forrester Phenotyping of Patients Presenting in Shock to the Emergency Department-A prospective Observational study

Shock resuscitation is one of the most challenging modalities faced by acute care providers, especially during the early hours of resuscitation. Shock, or hypoperfusion state, is a physiological derangement that needs to be corrected appropriately in a time-sensitive manner to prevent mortality and morbidity. The cornerstone in the management of shock is based on assessing the type of shock and resuscitating with fluids, vasopressors, and inotropes.Resuscitation is based on determining whether the patient has hypovolemic, distributive, cardiogenic, or obstructive shock. In recent decades, point-of-care ultrasound (POCUS) has been used during early resuscitation to identify the type of shock and augment the resuscitation process. Despite these advancements and regularly updated international treatment guidelines, the optimal therapeutic approach is controversial, especially with regard to intravenous (IV) fluids. It has been observed that even though patients are initially fluid responsive when resuscitated with IV fluids, may later show signs of venous congestion. The coexistence of venous congestion in more than 50% of patients who were fluid responsive has been reported. A personalised resuscitation approach has been suggested based on patients’ physiological derangement.

Point of Care-guided profiling uses dichotomised Velocity time integral (VTI) and Venous Excess Ultrasound (VEXUS) to classify these phenotypes. Our current study will use one more alternative surrogate for both to add to accuracy.