SHoC blog from @CanadiEM

Social media site @CanadiEM recently featured the @CJEMonline @IFEM2 #SHoC Consensus Protocol, featuring authors from @SJRHEM among others.

So why do we need another ultrasound protocol in emergency medicine? RUSHing from the original FAST scan, playing the ACES, FOCUSing on the CAUSE and meeting our FATE, it may seem SHoCking that many of these scanning protocols are not based on disease incidence or data on their impact, but rather on expert opinion. The Sonography in Hypotension (SHoC) protocols were developed by an international group of critical care and emergency physicians, using a Delphi consensus process, based upon the actual incidence of sonographic pathology detected in previously published international prospective studies [Milne; Gaspari]. The protocols are formulated to help the clinician utilize ultrasound to confirm or exclude common causes, and guides them to consider core, supplementary and additional views, depending upon the likely cause specific to the case.

Why would I take the time to scan the aorta of a 22 year old female with hypotension, when looking for pelvic free fluid might be more appropriate? Why would I not look for lung sliding, or B lines in a breathless shocked patient? Consideration of the shock category by addressing the “4 Fs” (fluid, form, function, and filling) will provide a sense of the best initial therapy and should help guide other investigations. Differentiating cardiogenic shock (a poorly contracting, enlarged heart, widespread lung B lines, and an engorged IVC) in an elderly hypotensive breathless patient, from sepsis (a vigorously contracting, normally sized or small heart, focal or no B lines, and an empty IVC) will change the initial resuscitation plan dramatically. Differentiating cardiac tamponade from tension pneumothorax in apparent obstructive shock or cardiac arrest will lead to dramatically differing interventions.

SHoC guides the clinician towards the more likely positive findings found in hypotensive patients and during cardiac arrest, while providing flexibility to tailor other windows to the questions the clinician needs to answer. One side does not fit all. That is hardly SHoCing news. Prospective validation of ultrasound protocols is necessary, and I look forward to future analysis of the effectiveness of these protocols.

References

Scalea TM, Rodriguez A, Chiu WC, et al. Focused Assessment with Sonography for Trauma (FAST): results from an inter- national consensus conference. J Trauma 1999;46:466-72.

Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. Journal of the American Society of Echocardiography. 2010 Dec 31;23(12):1225-30.

Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, Marshall J. C.A.U.S.E.: cardiac arrest ultra-sound exam – a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation 2008;76:198–206

Atkinson PR, McAuley DJ, Kendall RJ, et al. Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. Emerg Med J 2009;26:87–91

Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in Shock in the evaluation of the critically lll. Emerg Med Clin North Am 2010;28:29 – 56

Jensen MB, Sloth E, Larsen KM, Schmidt MB: Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol. 2004, 21: 700-707.

Gaspari R, Weekes A, Adhikari S, Noble VE, Nomura JT, Theodoro D, Woo M, Atkinson P, Blehar D, Brown SM, Caffery T. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation. 2016 Dec 31;109:33-9.

Milne J, Atkinson P, Lewis D, et al. (April 08, 2016) Sonography in Hypotension and Cardiac Arrest (SHoC): Rates of Abnormal Findings in Undifferentiated Hypotension and During Cardiac Arrest as a Basis for Consensus on a Hierarchical Point of Care Ultrasound Protocol. Cureus 8(4): e564. doi:10.7759/cureus.564

Sonography in Hypotension and Cardiac Arrest: The SHoC Consensus Statement

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SJRHEM Photo Competition – Results – Respect Category

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In 3rd Equal place (Two Photographs)….

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Peggy’s Cove Lighthouse

Cherie Adams 

 

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Bald Eagle, Rothesay Yacht Club

This eagle perched here for 2 days, patiently surveying the lagoon for prey.

David Lewis

 


In Second Place….

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Respecting Sisters

Beth Agar 

 


And the Winner is….

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Work Family

We argue, laugh, cry, spend holidays together, become friends, support, carry, & celebrate each other all hours of the day and night. We’re more than just coworkers. We’re not even just friends. We’re family.

Sonja Skodje 

 


 

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SJRHEM Photo Competition – Results – Integrity Category

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In 4th Equal Place (Three Photographs)….

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Balance

Hiking in Italy, we came across a hill covered in Inukshuks.  The scene from afar was beautiful set on a mountainous peak, but up close, the precariousness is apparent.

Caroline Mackay 

 

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Routine Checks

Keeping us safe, one routine check at a time. Thanks to the SJPD for keeping us all in line & being there when we need them most.

Sonja Skodje

 

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EM Residents

This group of residents demonstrate integrity in their approach to learning the skills required to become an Emergency Physician

Peter Ross

 


And the Winners are (Three Photographs are the joint winners)….

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Gross Morne Descent

Cherie Adams 

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Boat Work

Maritime Traditions: the beauty of a culture

Mike Howlett 

 

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Starboard Mooring

Cherie Adams 

 


 

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SJRHEM Photo Competition – Results – Fairness Category

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In 3rd place….

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Lookout

Cherie Adams 

 


In Second Place….

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Marriage Tree

An outdoor church used by slaves at the Magnolia Plantation in South Carolina.  This is the place where a man and women would secretly marry by jumping over a broom.

Erica Ataellahi

 


And the Winner is….

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Whole World in His Hands

My Dad’s Hands.. Taken by my sister Rose McKenna ( Ex ER Staff)

Sandra McCavour / Rose McKenna

 


 

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SJRHEM Photo Competition – Results – Caring Category

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In 3rd place….

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Last Embrace

Holding my Mom’s Hand as she took her last Breath

Sandra McCavour

 


In Second Place….

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Sibling love

Big sister, Khloe, age 6, didn’t want to leave her baby brother’s side, Karter, age 4 months, when he wasn’t feeling too well & being admitted to Pediatrics. Karter snuggled & calmed down, vital signs normalizing, with Khloe next to him.

Sonja Skodje 

 


And the Winner is….

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Silhouette Happiness

A classic moment of joy between a father and son

Mike Howlett

 


 

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SJRHEM Photo Competition – Shortlist and Results

Donate

If you would like to make a donation to the Saint John Regional Foundation – Jane Howlett Memorial Fund please follow this link.

 

Purchase Framed Prints

If you would like to purchase a framed print of any of the shortlisted photos please contact Beth Agar, Elizabeth.Agar@horizonnb.ca, for price, details etc. Proceeds from photo purchases will go to the Jane Howlett Memorial Fund.

 

The following photographs have been shortlisted and include the top 3 in each of the 5 categories for the SJRHEM photo competition. The winners (1st, 2nd and 3rd in each category) will be published tomorrow. The judges have commented on the high quality of photographs and the difficult job they had in choosing the best.The Judges are – Tracey Shipley (Communications Horizon), Margaret Melanson (VP Quality Patient Care Horizon), Dr Jo-Ann Talbott, Kevin Goggan (Photographer Horizon). All judges were blinded to the name of the photographer (they had access to an online file of all photos, the title and the narrative) and were asked to rank the top 2 photos in each category and the overall top 10

I have no doubt that, in addition to these photos, some of those not on this shortlist will also be seen on in our corridors in the near future. Thanks to all who entered!

*Update – The results are in – 

Caring Category

Fairness Category

Respect Category

Integrity Category

Open Category


Overall Winner


All Shortlisted Photos in the gallery below (click to view full size)…..

 

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