A Possible Role for Arterial Duplex and Hand Acceleration Time in Diagnosing and Managing Shock

Abstract

Shock represents a state when arterial perfusion is inadequate to supply the needs of cellular respiration, leading to anerobic metabolism, acidosis, and cell death. Although typically described in terms of blood pressure and heart rate, these measures can both lead to delayed recognition of shock and under appreciation of the severity of end-organ malperfusion. Recently, there has been increased interest in monitoring peripheral perfusion both to detect early shock and monitor the response to treatment. However, current methods are variable and, in some cases, require specialized equipment. We present a case in which duplex ultrasound assessment of peripheral palmar acceleration time identified a post-hemorrhagic shock state before it was clinically apparent. Bedside arterial duplex and hand acceleration time may provide a simple tool to assess the degree of shock and response to intervention.