Hi̇potansi̇f hastalarda ultrasonun etki̇nli̇ği̇

Purpose: In this study, we aimed to investigate if early diagnose and proper management can lessen morbidity and mortality in the patients presenting with shock by utilizing bedside ultrasonographic scanning and Rush (Rapid Ultrasound in Shock and Hipotansive) protocol. Materials and Methods: This cross-sectional prospective study was conducted in the Department of Emergency Medicine of the Çukurova University Medical Faculty with the approval of the ethical comittee, between August 1st, 2014 and November 30th, 2015. A hundred patients over the age of 18 and whose blood pressure was equal or less than 90/60 mmHg were included in this study. Bedside ultrasonography and RUSH protocol were performed in each patient to assess the reasons of hypotension and schock in the emergency department (ED). Findings: Thirty-five female and 65 male patients were included in the study. The mean age of the patients were 57.12±17.1. The complaints of the patients' on admission were hematemesis or hematochesia (17%), fatigue and decreased level of concioussness (13%), dyspnea (13%), decreased oral intake (12%) and trauma (18%). The most frequent finding was tachycardia (57%) and sinüs tachycardia (48%) in the Electrocardiyography. The most common type of shock was hypovolemic shock (55%) because of 50 patients' Inferiyor vena cava indexes were under 1.5 cm. The most common reason of the shock was hemorrhage. Eighteen percent of the patients were found to have free fluid in the abdomen by the FAST evaluation. Aortic aneurism was seen in one patient and aortic dissection was seen in three patients. Cardiogenic shock was diagnosed in nine patients, four were due to arhyttmia and five were due to decompansated hearth failure. Obstructive shock was diagnosed in nine patients (4 pericardial tamponades, 4 pulmonary thromboembolisms and 1 pneumothorax). By the RUSH protocol, initial diagnoses of the patients were hypovolemic shock (55 patients), distributional shock (19 patients), cardiogenic shock (8 patients), obstructive shock (6 patients) and complex shock (12 patients). Poor clinical progression was seen in 60% of our patients where 56% of patients were transferred to intensive care unit and 4% mortalities in the ED. Good clinical progression was seen in the 40% vof our patients, 14% were discharged from the ED while 26% were hospitalized in the different wards. Result: Rush protocol is an early systematic approach, a practical and effective method to evaluate patients with hypotension and shock in the ED. It is useful in early diagnosing of hypotension and shock reasons by evaluating heart pump function, body volume condition and vessel evaluation. Keywords: Hypotension, Emergency Department, Ultrasonography, RUSH