Non-cardiac Ultrasound Signs in Shock

  • Becky X. Lou
  • Paul H. Mayo
Part of the Lessons from the ICU book series (LEICU)


This chapter reviews non-cardiac ultrasonography findings that are relevant to the management of shock in both trauma and non-trauma patients. These include assessment for occult hemorrhage and source of sepsis.


Ultrasonography (US) Shock Whole-body ultrasonography (WBU) Focused assessment with Sonography in Trauma (FAST) Sepsis Trauma 


Conflicts of Interest

Becky Lou MD and Paul H. Mayo MD have no conflicts of interest regarding the content of this chapter.

Supplementary material

Video 19.1

(MP4 6212 kb)

Video 19.2

(MP4 4944 kb)

Video 19.3

(MP4 4600 kb)

Video 19.4

(MP4 8040 kb)

Video 19.5

(MP4 5335 kb)

Video 19.6

(MP4 4159 kb)

Video 19.7

(MP4 7120 kb)

Video 19.8

(MP4 4372 kb)

Video 19.9

(MP4 13202 kb)

Video 19.10

(MP4 15933 kb)

Video 19.11

(MP4 4291 kb)

Video 19.12

(MP4 5598 kb)

Video 19.13

(MP4 5500 kb)

Video 19.14

(MP4 8580 kb)

Video 19.15

(MP4 9851 kb)

Video 19.16

(MP4 10011 kb)

Video 19.17

(MP4 10544 kb)

Video 19.18

(MP4 6475 kb)

Video 19.19

(MP4 3779 kb)

Video 19.20

(MP4 1493 kb)

Video 19.21

(MP4 1289 kb)


  1. 1.
    Narasimhan M, Koenig SJ, Mayo PH. A whole-body approach to point of care ultrasound. Chest. 2016;150(4):772–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Volpicelli G, Lamorte A, Tullio M, Cardinale L, Giraudo M, Stefanone V, Boero E, Nazerian P, Pozzi R, Frascisco MF. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med. 2013;39(7):1290–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Laursen CB, Sloth E, Lambrechtsen J, Lassen AT, Madsen PH, Henriksen DP, Davidsen JR, Rasmussen F. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest. 2013;144(6):1868–75.CrossRefPubMedGoogle Scholar
  4. 4.
    Lichtenstein D, Axler O. Intensive use of general ultrasound in the intensive care unit. Intensive Care Med. 1993;19(6):353–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma. 1999;46(3):466–72.CrossRefPubMedGoogle Scholar
  6. 6.
    Moylan M, Newgard CD, Ma OJ, Sabbaj A, Rogers T, Douglass R. Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients. J Emerg Med. 2007;33(3):265–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Ollerton JE, Sugrue M, Balogh Z, D’Amours SK, Giles A, Wyllie P. Prospective study to evaluate the influence of FAST on trauma patient management. J Trauma. 2006;60(4):785–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Savatmongkorngul S, Wongwaisayawan S, Kaewlai R. Focused assessment with sonography for trauma: current perspectives. Open Access Emerg Med. 2017;9:57.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Jehle DV, Stiller G, Wagner D. Sensitivity in detecting free intraperitoneal fluid with the pelvic views of the FAST exam. Am J Emerg Med. 2003;21(6):476–8.CrossRefGoogle Scholar
  10. 10.
    Barbosa RR, Rowell SE, Fox EE, Holcomb JB, Bulger EM, Phelan HA, Alarcon LH, Myers JG, Brasel KJ, Muskat PC, Del Junco DJ. Increasing time to operation is associated with decreased survival in patients with a positive FAST exam requiring emergent laparotomy. J Trauma. 2013;75(101):S48.CrossRefGoogle Scholar
  11. 11.
    Richards JR, McGahan JP. Focused assessment with sonography in trauma (FAST) in 2017: what radiologists can learn. Radiology. 2017;283(1):30–48.CrossRefPubMedGoogle Scholar
  12. 12.
    Reardon R, Moscati R. Beyond the FAST Exam: additional applications of sonography in trauma. In: Jehle D, Heller M, editors. Ultrasonography in trauma: the FAST exam. Dallas, TX: American College of Emergency Physicians; 2003. p. 107–26.Google Scholar
  13. 13.
    Rowan KR, Kirkpatrick AW, Liu D, Forkheim KE, Mayo JR, Nicolaou S. Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT—initial experience. Radiology. 2002;225(1):210–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care. 2014;20:315–22.CrossRefPubMedGoogle Scholar
  15. 15.
    Volpicelli G. Sonographic diagnosis of pneumothorax. Intensive Care Med. 2011;37(2):224–32.CrossRefPubMedGoogle Scholar
  16. 16.
    Sekiguchi H, Suzuki J, Daniels CE. Making paracentesis safer: a proposal for the use of bedside abdominal and vascular ultrasonography to prevent a fatal complication. Chest. 2013;143(4):1136–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Choi S, Trieu J, Ridley L. Radiological review of intercostal artery: anatomical considerations when performing procedures via intercostal space. J Med Imaging Radiat Oncol. 2010;54(4):302–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Helm EJ, Rahman NM, Talakoub O, Fox DL, Gleeson FV. Course and variation of the intercostal artery by CT scan. Chest. 2013;143(3):634–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Shurtleff E, Olinger A. Posterior intercostal artery tortuosity and collateral branch points: a cadaveric study. Folia Morphol (Warsz). 2012;71(4):254–1.Google Scholar
  20. 20.
    Kanai M, Sekiguchi H. Avoiding vessel laceration in thoracentesis: a role of vascular ultrasound with color doppler. Chest. 2015;147(1):e5–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Kopterides P, Lignos M, Papanikolaou S, Papadomichelakis E, Mentzelopoulos S, Armaganidis A, Panou F. Pleural effusion causing cardiac tamponade: report of two cases and review of the literature. Heart Lung. 2006;35(1):66–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Traylor JJ, Chan K, Wong I, Roxas JN, Chandraratna PA. Large pleural effusions producing signs of cardiac tamponade resolved by thoracentesis. Am J Cardiol. 2002;89(1):106–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Antoniou GA, Koutsias S, Antoniou SA, Georgiakakis A, Lazarides MK, Giannoukas AD. Outcome after endovascular stent graft repair of aortoenteric fistula: a systematic review. J Vasc Surg. 2009;49(3):782–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, Akoumianaki E, Georgopoulos D. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011;37(9):1488.CrossRefPubMedGoogle Scholar
  25. 25.
    Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9–15.CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Intensive Care Medicine 2019

Authors and Affiliations

  • Becky X. Lou
    • 1
  • Paul H. Mayo
    • 1
  1. 1.Zucker School of Medicine at Hofstra/Northwell HealthNew Hyde ParkUSA

Personalised recommendations