TY - JOUR T1 - Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension JF - Emergency Medicine Journal JO - Emerg Med J SP - 87 LP - 91 DO - 10.1136/emj.2007.056242 VL - 26 IS - 2 AU - P R T Atkinson AU - D J McAuley AU - R J Kendall AU - O Abeyakoon AU - C G Reid AU - J Connolly AU - D Lewis Y1 - 2009/02/01 UR - http://emj.bmj.com/content/26/2/87.abstract N2 - Background: Non-traumatic undifferentiated hypotension is a common critical presentation in the emergency department. In this group of patients, early diagnosis and goal-directed therapy is essential for an optimal outcome. The usefulness of focused bedside ultrasound is reviewed and a protocol for Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) is proposed.Methods: The protocol consists of six windows including cardiac, peritoneal, pleural, inferior vena cava and aortic views, and aims to shorten the time period taken to establish a diagnosis and hence to deliver the most appropriate goal-directed therapy. Its use in seven case examples is described.Results: In all cases the ACES protocol helped in guiding the initial management while further information was obtained.Conclusion: The six-view ACES protocol is a useful adjunct to clinical examination in patients with undifferentiated hypotension in the emergency department. A prospective randomised trial or multicentre database/registry is needed to investigate the validity and impact of this protocol on the early diagnosis and management of hypotensive patients. ER -