Emergency physician. Under graduate (MBBS) from University Malaya 2007. Post Graduate in Master (EMMED) from University Kebangsaan Malaysia in 2016. Currently pursuing fellowship in Emergency Critical Care. Passion/interest in critical care, emergency cardiology.
Refractory shock encompasses a broad range of etiology. In all cases, early recognition and early intervention of the cause of shock aiming to restore normal hemodynamics in order to prevent the progression towards multi organ failure and death.
Transthoracic echocardiography (TTE), along with multi organ POCUS represents as a fundamental tool to expedite the diagnostic evaluation of undifferentiated shock patient at the bedside.
TTE provide precise cause of circulatory shock, evaluation of hemodynamic state and helps the clinicians to choose the best therapeutic interventions.
Cardiac arrest is one of the most challenging presentations managed by emergency care providers. For many years, transthoracic echocardiography (TTE) has been incorporated in the standard ACLS algorithm and represents a valuable component in resuscitation management CA patients. While TTE has many benefits in the management of cardiac arrest, it is not without shortcomings.
An important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. Focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis—those in cardiac arrest and peri-arrest states.
In addition to the same diagnostic and prognostic role provided by TTE images, TEE provides unique advantages including the potential to optimize the quality of chest compressions, shorten cardiopulmonary resuscitation interruptions, guide resuscitative procedures, and provides a continuous image of myocardial activity.
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