Ultrasonography for the differential diagnosis of shock at the prehospital stage of emergency medical care

Introduction. The ambulance intensive care medical staff are the first ones who take care of critically ill patients. The diagnosis is often not clear, so treatment may not be optimal, which will lead to a worsening of the patient›s condition. The prehospital diagnostic capabilities of are limited. There is a need for informative, safe, and fast methods of examining critically ill patients. Ultrasound diagnostics seems to be just such a convenient and effective method.

The purpose of the work. To evaluate the effect of ultrasonography on the accuracy of diagnosis in patients with different types of shock, developed prehospitally, as well as on the hemodynamic state of patients at the time of their admission to the hospital.

Materials and methods. A prospective cohort study was conducted: a comparison was performed between two groups of patients over the age of 18 who were diagnosed with traumatic, hypovolemic, or cardiogenic shock by ambulance intensive care teams. The first group (67 patients) underwent ultrasound with a portable ultrasound scanner using the eFast protocol, followed by measurement of the diameter of the IVC during inhalation and exhalation and calculation of the IVC collapsibility index. The second group (97 patients) was a control group, without performing ultrasound. The following parameters were analyzed for both groups: the dynamics of blood pressure, pulse, and the Algover index, the volume of infusion, the total time of prehospital (ambulance) care, and difference in the diagnoses of the ambulance and the hospital.

Results and discussion. In patients with traumatic shock, the diagnosis was correctly established in 90% of cases, in the control group — i n 77% of cases. In patients with hypovolemic shock, the diagnosis was correctly established in 91%, in the control group — in 85%. There were no differences in diagnostic accuracy between the groups for cardiogenic shock. In patients of the first group with signs of traumatic and hypovolemic shocks, a statistically significant increase in systolic and mean blood pressure, a decrease in heart rate and the Algover index were detected after prehospital treatment. The volume of intravenous infusion in the first group was also significantly higher. The ultrasound did not affect the duration of prehospital medical care.

Conclusion. Emergency ultrasound performed on ambulance for patients in a state of traumatic and hypovolemic shock is appeared to be an informative method that affects the therapeutic tactics of the ambulance intensive care teams. It is associated with higher hemodynamic parameters of patients admitting to the hospital after prehospital therapy. It leads to a statistically significant decrease in the differences in diagnoses of the ambulance and hospital.

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