Beyond plumbing: the multidisciplinary ultrasound assessment of shock and hypotension in the emergency department
The management of shock is a time-critical challenge in emergency medicine and critical care. Point-of-care ultrasound (POCUS) has revolutionised this paradigm, offering rapid, non-invasive bedside assessments. Recognising its diagnostic power, the Royal College of Emergency Medicine formally mandates ‘ultrasound-assisted shock assessment’ as a core competency.
However, shock is a profound systemic derangement requiring more than basic screening. This article explores the structured, time-phased approach to ultrasound in shock. We propose a two-protocol framework: the RUSH (rapid ultrasound in shock) examination during the first five minutes for immediate threat exclusion, followed by the comprehensive SHOCK ultrasound assessment – evaluating stroke volume, hypoperfusion, overload, catastrophes and kinetics – from 15 to 30 minutes onward to guide individualised resuscitation.
Crucially, POCUS is not a one-off scan; it guides highly individualised resuscitation, utilising AI and serial monitoring. Yet, for ultrasound to be safely utilised, robust clinical governance is required. By combining the clinical acumen of acute physicians with the technical optimisation and the quality assurance frameworks, ultrasound serves as an indispensable tool as an extension of clinical assessment of patients in shock.
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