FALLS protocol: Difference between revisions

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==Background==
==Background==
*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>
*The FALLS-protocol is an ultrasound evaluation of patients with acute circulatory failure
*The FALLS-protocol is an ultrasound evaluation based protocol for the assessment 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
**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>==
==FALLS-Protocol<ref>Lichtenstein D. FALLS-protocol: lung ultrasound in hemodynamic assessment of shock. Heart, Lung and Vessels 2013; 5(3):142-147.</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
 
*Cardiogenic shock - B-profile on itial ultrasound


==On which patients to use==
With FALLS Protocol
A shocked patient with an A-profile - called a FALLS-responder.
*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
 
==See Also==
*[[Ultrasound (Main)]]


==Sources==
==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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