Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension

Emerg Med J. 2009 Feb;26(2):87-91. doi: 10.1136/emj.2007.056242.


Background: Non-traumatic undifferentiated hypotension is a common critical presentation in the emergency department. In this group of patients, early diagnosis and goal-directed therapy is essential for an optimal outcome. The usefulness of focused bedside ultrasound is reviewed and a protocol for Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) is proposed.

Methods: The protocol consists of six windows including cardiac, peritoneal, pleural, inferior vena cava and aortic views, and aims to shorten the time period taken to establish a diagnosis and hence to deliver the most appropriate goal-directed therapy. Its use in seven case examples is described.

Results: In all cases the ACES protocol helped in guiding the initial management while further information was obtained.

Conclusion: The six-view ACES protocol is a useful adjunct to clinical examination in patients with undifferentiated hypotension in the emergency department. A prospective randomised trial or multicentre database/registry is needed to investigate the validity and impact of this protocol on the early diagnosis and management of hypotensive patients.

Publication types

  • Case Reports

MeSH terms

  • Abdomen / diagnostic imaging*
  • Adult
  • Aged, 80 and over
  • Cardiovascular Diseases / diagnostic imaging*
  • Clinical Protocols
  • Emergencies
  • Emergency Treatment
  • Female
  • Humans
  • Hypotension / diagnostic imaging*
  • Hypotension / etiology
  • Male
  • Middle Aged
  • Point-of-Care Systems
  • Shock / diagnostic imaging*
  • Shock / etiology
  • Ultrasonography
  • Young Adult