Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

Point-of-care ultrasound, or POCUS, has gathered significant interest as a tool to augment clinical decision-making in the care of acutely ill patients. Patients with hemodynamic instability, in particular, require immediate intervention and are at high risk for further cardiovascular and/or respiratory decompensation. POCUS examination of these patients, therefore, requires a protocol that is sufficient to answer clinicians' questions while still retaining adequate brevity to be feasible in a short period of time at the bedside. Here, we demonstrate a protocol for obtaining such information by the Echocardiographic Assessment using Subxiphoid-Only - Mean Arterial Pressure, or EASy MAP exam, a focused ultrasonographic assessment of the cardiovascular and respiratory systems. The cardiovascular portion of the examination utilizes the subcostal window to obtain views of the heart and inferior vena cava (IVC); this is then supplemented by anterior upper lung and posterolateral diaphragmatic pleural views for the respiratory portion. All six views (cardiac, IVC, left and right anterior upper lung, and left and right posterolateral pleural) are obtained using a low-frequency phased array transducer. We discuss some of the common pitfalls encountered in obtaining these images and the basics of interpreting the most common findings; also described is a 12-point scale for rating the quality of the images obtained from the cardiac view and a small number of supplementary views that may be considered when clinically relevant.