FALLS protocol: Difference between revisions
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Based on a review article<ref>http://www.heartlungandvessels.org/index.php?pag=rivista_articles&id_numero=1&id_articolo=223</ref> by David Lichtenstein<ref>http://www.ncbi.nlm.nih.gov/pubmed/?term=Lichtenstein+D%5BAuthor%5D</ref>
==Background==
*The FALLS-protocol is an ultrasound evaluation of patients with acute circulatory failure
**Includes evaluation of the pleura, lungs, and pericardium using ultrasound in a step-wise fashion to categorize circulatory shock is present according to Weil's shock classification


==What it is==
==FALLS-Protocol<ref>Lichtenstein D. FALLS-protocol: lung ultrasound in hemodynamic assessment of shock. Heart, Lung and Vessels 2013; 5(3):142-147.</ref>==
The FALLS-protocol is an ultrasound evaluation based protocol for the assessment of patients with acute circulatory failure.
It relies on the evaluation of the pleura, lungs and pericardium using ultrasound to in a step wise fashion try to define which type of circulatory shock is present (according to Weil's shock classification).


==FALLS-Protocol<ref>http://www.heartlungandvessels.org/index.php?pag=rivista_articles&id_numero=1&id_articolo=223</ref>==
[[File:falls protocol.jpg]]


[[File:falls protocol.jpg]]
==Appropriate Patient==
A shocked patient who presents initially with an A-profile - termed a FALLS-responder


==Endpoints==
==Endpoints==
Administration of iv fluid until clinical improvement or development of a B-profile.
Prior to FALLS Protocol (BLUE-Protocol)
*Obstructive shock - Tamponade or pneumothorax on initial ultrasound


==On which patients to use==
*Cardiogenic shock - B-profile on itial ultrasound
A shocked patient with an A-profile - called a FALLS-responder.
 
With FALLS Protocol
*Hypovolemic shock - Improvement after IVF
*Septic shock - B-profile and continued failure after IVF


==Limitations==
==Limitations==
No value in patients presenting with B-profile - no endpoint can be defined.
*Patients presenting with B-profile have a larger differential such as cardiogenic shock, pulmonary fibrosis, diastolic failure, etc
Cardiogenic shock with no lung edema - e.g. right ventricular infarction - are associated with an A-profile.
*Cardiogenic shock with no lung edema - e.g. right ventricular infarction - are associated with an A-profile


==Sources==
==See Also==
*[[Ultrasound (Main)]]
 
==References==
<references/>
<references/>
[[Category:Radiology]]
[[Category:Ultrasound]]
[[Category:Critical Care]]

Latest revision as of 20:35, 7 January 2017

Background

  • The FALLS-protocol is an ultrasound evaluation of patients with acute circulatory failure
    • Includes evaluation of the pleura, lungs, and pericardium using ultrasound in a step-wise fashion to categorize circulatory shock is present according to Weil's shock classification

FALLS-Protocol[1]

Falls protocol.jpg

Appropriate Patient

A shocked patient who presents initially with an A-profile - termed a FALLS-responder

Endpoints

Prior to FALLS Protocol (BLUE-Protocol)

  • Obstructive shock - Tamponade or pneumothorax on initial ultrasound
  • Cardiogenic shock - B-profile on itial ultrasound

With FALLS Protocol

  • Hypovolemic shock - Improvement after IVF
  • Septic shock - B-profile and continued failure after IVF

Limitations

  • Patients presenting with B-profile have a larger differential such as cardiogenic shock, pulmonary fibrosis, diastolic failure, etc
  • Cardiogenic shock with no lung edema - e.g. right ventricular infarction - are associated with an A-profile

See Also

References

  1. ↑ Lichtenstein D. FALLS-protocol: lung ultrasound in hemodynamic assessment of shock. Heart, Lung and Vessels 2013; 5(3):142-147.
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