FALLS protocol

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.