Utility of ultrasound in resuscitation | Colombian Journal of Anesthesiology

array:24 ["pii" => "S2256208715000371" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.05.001" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "219" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2015;43:321-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2529 "formatos" => array:3 [ "EPUB" => 94 "HTML" => 2046 "PDF" => 389 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S012033471500043X" "issn" => "01203347" "doi" => "10.1016/j.rca.2015.03.011" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "219" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2015;43:321-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4864 "formatos" => array:3 [ "EPUB" => 107 "HTML" => 3755 "PDF" => 1002 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Revisión" "titulo" => "Utilidad de la ecografía en reanimación" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "330" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Utility of ultrasound in resuscitation" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0080" "etiqueta" => "Figura 16" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr16.jpeg" "Alto" => 1120 "Ancho" => 1658 "Tamanyo" => 115358 ] ] "descripcion" => array:1 [ "es" => "Cuadrante superior izquierdo del EFAST. Observe en el espacio supradiafragmático una zona hipoecoica indicativa de líquido (L) y la hepatización del pulmón dándole apariencia de órgano sólido (H). D: Diafragma. Fuente: autores." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan David Pérez-Coronado, Germán Andrés Franco-Gruntorad" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Juan David" "apellidos" => "Pérez-Coronado" ] 1 => array:2 [ "nombre" => "Germán Andrés" "apellidos" => "Franco-Gruntorad" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2256208715000371" "doi" => "10.1016/j.rcae.2015.05.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000371?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S012033471500043X?idApp=UINPBA00004N" "url" => "/01203347/0000004300000004/v1_201510300044/S012033471500043X/v1_201510300044/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2256208715000565" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.06.005" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "229" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2015;43:331-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2273 "formatos" => array:3 [ "EPUB" => 111 "HTML" => 1720 "PDF" => 442 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "Ergonomics in ultrasound-guided nerve blocks" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "331" "paginaFinal" => "339" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ergonomía en los bloqueos nerviosos guiados por ultrasonografía" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1794 "Ancho" => 2437 "Tamanyo" => 189831 ] ] "descripcion" => array:1 [ "en" => "(A) (along the visual axis) and (B) (across the visual axis): monitor, transducer, needle and operator orientation in relation to the visual axis." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Oscar David Aguirre-Ospina, Julián Felipe González-Maldonado, Ángela María Ríos-Medina" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Oscar David" "apellidos" => "Aguirre-Ospina" ] 1 => array:2 [ "nombre" => "Julián Felipe" "apellidos" => "González-Maldonado" ] 2 => array:2 [ "nombre" => "Ángela María" "apellidos" => "Ríos-Medina" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334715000714" "doi" => "10.1016/j.rca.2015.06.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715000714?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000565?idApp=UINPBA00004N" "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000565/v1_201510250024/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2256208715000346" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.04.006" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "216" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2015;43:314-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2179 "formatos" => array:3 [ "EPUB" => 92 "HTML" => 1770 "PDF" => 317 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "Ultrasound applications in the central nervous system for neuroanaesthesia and neurocritical care" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "314" "paginaFinal" => "320" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aplicaciones de la ultrasonografía en el sistema nervioso central para Neuroanestesia y cuidado neurocrítico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 993 "Ancho" => 2666 "Tamanyo" => 190551 ] ] "descripcion" => array:1 [ "en" => "Visualization of the structures in a patient through the temporal bone window. Source: authors." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucas Ochoa-Pérez, Alejandro Cardozo-Ocampo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Lucas" "apellidos" => "Ochoa-Pérez" ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Cardozo-Ocampo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334715000404" "doi" => "10.1016/j.rca.2015.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715000404?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000346?idApp=UINPBA00004N" "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000346/v1_201510250024/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "Utility of ultrasound in resuscitation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "330" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan David Pérez-Coronado, Germán Andrés Franco-Gruntorad" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Juan David" "apellidos" => "Pérez-Coronado" "email" => array:1 [ 0 => "perezjuand@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Germán Andrés" "apellidos" => "Franco-Gruntorad" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Resident in Anesthesiology, Fundación Cardioinfantil, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cardiovascular Anesthesiologist, Fundación Cardioinfantil, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Calle 163a Número 13B - 60. Segundo Piso Torre A. Fundación Cardioinfantil Instituto de Cardiología. Bogotá, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del Ultrasonido en Reanimación" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0060" "etiqueta" => "Fig. 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 1102 "Ancho" => 1658 "Tamanyo" => 175848 ] ] "descripcion" => array:1 [ "en" => "Apical 4-chamber window in M-mode. Tricuspid annular plane systolic excursion (TAPSE) (blue line). Normal value greater than 1.5cm." ] ] ] "textoCompleto" => "IntroductionUltrasound technology has become one of the most useful diagnostic and therapeutic tools of our time. Since leaving the exclusive domain of radiologists and being used by Emergency and Intensive Care Unit (ICU) departments, the ultrasound has arrived in the operating room and is now a tool for perioperative care, regional anesthetics, and vascular access.In the 1970s, the use of echocardiography in the ICU was limited to evaluating systolic volume and cardiac output.<a class="elsevierStyleCrossRef" href="#bib0275">1</a> In the 1980s and 1990s, it quickly developed to aid in the identification of acute events like cardiac tamponade,<a class="elsevierStyleCrossRef" href="#bib0280">2</a> complications from myocardial infarction,<a class="elsevierStyleCrossRef" href="#bib0285">3</a> hemodynamic assessments in cases of hypotension,<a class="elsevierStyleCrossRef" href="#bib0290">4</a> sepsis,<a class="elsevierStyleCrossRef" href="#bib0295">5</a> and the detection of ruptured aortic aneurisms.<a class="elsevierStyleCrossRef" href="#bib0300">6</a>In trauma, the use of the ultrasound began in 1980 in Europe and Japan.<a class="elsevierStyleCrossRef" href="#bib0305">7</a> In 1992, it was used in the USA to detect hemoperitoneum in cases of closed abdominal trauma.<a class="elsevierStyleCrossRef" href="#bib0310">8</a> Rozycki and collaborators demonstrated the effectiveness of ultrasonography in detecting pericardial effusion and intraperitoneal fluid with 81% sensitivity and 99% specificity. They described it with the acronym “FAST” (Focused Abdominal Sonography for Trauma) for evaluating abdominal trauma.<a class="elsevierStyleCrossRef" href="#bib0315">9</a> In 1997, through international consensus, the ‘A’ was changed from “Abdominal” to “Assessment” and it was included in ATLS.<a class="elsevierStyleCrossRef" href="#bib0320">10</a> In addition, there are a great quantity of studies on the utility of ultrasonography in other scenarios such as pneumothorax,<a class="elsevierStyleCrossRef" href="#bib0325">11</a> hemothorax,<a class="elsevierStyleCrossRef" href="#bib0330">12</a> and vascular accesses.<a class="elsevierStyleCrossRefs" href="#bib0335">13–15</a>Thanks to these descriptions, many algorithms for the use of ultrasounds in resuscitation have been published (FATE, CAUSE, RUSH), and, in 2004, the American College of Emergency Physicians (ACEP) considered that bedside ultrasonography should be integrated into routine practice. In 2010, the American Heart Association guides for advanced life support recommend echocardiography for diagnosing treatable causes of cardiac arrest where defibrillation is impossible and to orient treatment.<a class="elsevierStyleCrossRef" href="#bib0350">16</a>What has been the impact of ultrasonography in resuscitation?Its impact can be seen in the reduction of morbidity and mortality from trauma, the recognition of potentially reversible causes of non-shockable cardiac arrest and shock, the prediction of survival, in decision-making in cases of acute respiratory failure, and in the reduction of complications from invasive procedures.TraumaFAST consists of the evaluation of four points (pericardial, perihepatic, perisplenic, and pelvic (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>)) to detect hypoechoic images related to free pericardial and intra-abdominal fluids of up to 100ml (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) with a sensitivity of 50–88%. Its application has managed to reduce mortality from cardiac and abdominal trauma.<a class="elsevierStyleCrossRef" href="#bib0355">17</a> Its extended application to the thorax (EFAST) for detecting pneumothorax and hemothorax has been very important.<a class="elsevierStyleCrossRef" href="#bib0360">18</a> Firstly this is because it is more sensitive than radiography techniques for diagnosing pneumothorax (48% vs. 20%),<a class="elsevierStyleCrossRef" href="#bib0355">17</a> a pathology that is calculated to be hidden in 5% of all traumas<a class="elsevierStyleCrossRef" href="#bib0365">19</a> and in up to 55% of severe traumas.<a class="elsevierStyleCrossRef" href="#bib0370">20</a> Secondly, echography may detect fluid with a volume of 20ml while radiography detects 200ml.<a class="elsevierStyleCrossRef" href="#bib0375">21</a> Thus, echography has a superior sensitivity and specificity when it comes to detecting hemothorax.<a class="elsevierStyleCrossRef" href="#bib0380">22</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Cardiac arrest and shockSurvival for Pulseless Electric Activity (PEA) and asystole is much less than for other cardiac arrest rhythms. This is probably due to the fact that they depend on the correct identification and rapid treatment of underlying causes.<a class="elsevierStyleCrossRef" href="#bib0350">16</a> Of these causes, only hypoxemia, hypothermia, and hypo/hyperkalemia are easily diagnosed.<a class="elsevierStyleCrossRef" href="#bib0385">23</a> Furthermore, only 45% of physicians correctly diagnose a lack of pulse in cardiac arrest without differentiating between PEA and pseudo PEA. This may lead to physicians not treating a reversible cause.<a class="elsevierStyleCrossRef" href="#bib0385">23</a>In shock, morbidity and mortality also depend on the duration and the rapid treatment of the cause. However, the clinical differentiation between hypovolemic, distributive, cardiogenic, or obstructive shock cannot always be correctly performed<a class="elsevierStyleCrossRef" href="#bib0390">24</a> since the physical examination detects only 57% of cardiac anomalies.<a class="elsevierStyleCrossRef" href="#bib0395">25</a>Ultrasonography plays an important role in these non-shockable cardiac arrest and shock scenarios since it allows physicians to rapidly exclude potentially reversible causes of cardiogenic shock, hypovolemia, cardiac tamponade, pneumothorax, and hemothorax.<a class="elsevierStyleCrossRefs" href="#bib0385">23–25</a> Moreover, it increases the exactness of the cardiac physical examination by 60–90% for pericardial effusion, left ventricular function, and cardiomegaly.<a class="elsevierStyleCrossRef" href="#bib0400">26</a> It also helps to differentiate a pseudo PEA from a true one so that behavior can be changed in up to 78% of cases.<a class="elsevierStyleCrossRef" href="#bib0405">27</a>Predicting survivalUltrasonography has been suggested as a tool for ceasing resuscitation since, when there is no evidence of myocardial contractility, the probability of return of spontaneous circulation is 3% in cases of PEA<a class="elsevierStyleCrossRef" href="#bib0410">28</a> and the probability of survival is 2% in cases of trauma.<a class="elsevierStyleCrossRef" href="#bib0415">29</a>Acute respiratory failureProper decision-making in this scenario was documented in 2008 with the BLUE protocol, an observational study that evaluated criteria like pleural sliding and the consolidation and presence of A or B lines in 3 zones of the thorax called: zone 1 (anterior), zone 2 (lateral), and zone 3 (postero-lateral). Each of these zones is halved to create a total of 6 investigation areas. Based on these findings, 6 profiles were established (A, A′, B, B′, AB, C) that, compared to the final diagnosis, had a sensitivity and specificity of greater than 80% and 90% respectively for detecting COPD, asthma, pneumothorax, pulmonary edema, pneumonia, and pulmonary thromboembolism.<a class="elsevierStyleCrossRef" href="#bib0420">30</a>In addition, echography has a high concordance with radiography in various acute pulmonary pathologies (effusions, consolidation, edema) and can be performed in less time.<a class="elsevierStyleCrossRef" href="#bib0425">31</a>Invasive proceduresWhen inserting a central venous catheter (CVC), ultrasonography reduced mechanical complications and insertion time, especially in the internal jugular.<a class="elsevierStyleCrossRef" href="#bib0430">32</a> Furthermore, it determines the correct placement of the point of the CVC with a sensitivity of 70% and a specificity of 100% with the saline flush test.<a class="elsevierStyleCrossRef" href="#bib0435">33</a> In cases of thoracentesis, ultrasound increases the probability of success and reduces the risk of organ puncture.<a class="elsevierStyleCrossRef" href="#bib0440">34</a> For pericardiocentesis, the incidence of complications drops 50–4.7%.<a class="elsevierStyleCrossRef" href="#bib0445">35</a>What does a non-expert need to train themselves and how reliable is it?The American Society of Echocardiography (ASE) determines that the main use of portable ultrasound is to extend the exactitude of the physical examination. It should be objective-guided. For this to take place, at least a basic level of training, including performing 75 examinations and interpreting 150, is required.<a class="elsevierStyleCrossRef" href="#bib0450">36</a>The Council of Emergency Medicine Residency Directors recommends that Emergency training programs include 2weeks/80h of training and 150 evaluations in critical situations, including 40 FAST examinations, 30 deep vein thrombosis (DVT) examinations, and 10 procedure examinations.<a class="elsevierStyleCrossRef" href="#bib0455">37</a>Intensive care programs recommend training in general concepts that include the pleura, thorax, vascular system, and abdomen in addition to basic echocardiography to recognize blood volume, biventricular function, cardiac tamponade, and severe acute valve failure.<a class="elsevierStyleCrossRef" href="#bib0460">38</a> 10h of theoretical training in each module and 30 trans-thoracic echocardiograms are recommended.<a class="elsevierStyleCrossRef" href="#bib0465">39</a>Several studies have shown the correlation of non-expert personnel and expert personnel in specific situations. Niendorff et al.<a class="elsevierStyleCrossRef" href="#bib0470">40</a> evaluated residents that received training in the subcostal window for recognizing cardiac tamponade, pulmonary embolism, hypovolemia, and reduction in contractility with a concordance in 80% over 7min in PEA scenarios. Another study, performed on residents and involving 100 cases found a strong correlation in terms of the evaluation of left ventricular function, and pleural, pericardial and moderate effusion to quantify vena cava and valve failure in 6min.<a class="elsevierStyleCrossRef" href="#bib0475">41</a>How to perform and evaluation with echography in resuscitation?There are many protocols described in the literature that include echocardiography, EFAST, the lung, the aorta, the vena cava, DVT, and ectopic pregnancy, etc. For example, the consensus from the ACEP on echocardiograms at the patient's bedside is focused on pericardial effusion, systolic function, right ventricular growth, intravascular volume, and on confirming transvenous pacemakers.<a class="elsevierStyleCrossRef" href="#bib0480">42</a> The FATE protocol (Focus Assessed Transthoracic Echocardiographic) focuses its evaluation on pericardial effusion, the thickness and dimensions of the heart chambers, contractility, and on the pleura.<a class="elsevierStyleCrossRef" href="#bib0485">43</a> The RUSH (Rapid Ultrasound in Shock) protocol establishes a standpoint for differentiating between hypovolemic, cardiogenic, distributive, and obstructive shock based on 3 variables: (1) The pump (pericardial effusion, left ventricular contractility, and dilation of the right ventricle), (2) the tank (inferior vena cava for hypovolemia, EFAST or pulmonary edema to evaluate leaks and pneumothorax for compression), and (3) the pipes (aortic aneurism and DVT).<a class="elsevierStyleCrossRef" href="#bib0390">24</a>Of these variables we must choose the most relevant ones for evaluating critical events in operating rooms such as shock with unclear etiology, cardiorespiratory arrest with non-shockable rhythms, and hypoxemia. The evaluation should be organized and directed depending on the clinical situation and should include: left ventricular function to rule out myocardial dysfunction, volume responsiveness to evaluate hypovolemia, pericardial effusion for cardiac tamponade, dilation of the right ventricle for pulmonary embolism, and pulmonary ultrasound to rule out pneumothorax, hemothorax, and pulmonary edema.Left ventricular systolic functionContractility can be evaluated qualitatively and quickly through the thickening of the endocardium to differentiate between normal and severe dysfunction. This approach is useful for determining the presence of cardiogenic shock and for guiding the use of inotropic/vasopressor medications or intravenous fluids.<a class="elsevierStyleCrossRef" href="#bib0490">44</a> The standard quantitative evaluation is the calculation of the ejection fraction using Simpson's method. However, this requires 2 planes (apical 4-chamber and 2-chamber) and an advanced calculation that is not always available in these scenarios.<a class="elsevierStyleCrossRef" href="#bib0495">45</a> The M-mode (movement in time) is a more simple method used in the FATE protocol. It allows for the calculation of the shortening fraction (normal greater than 25%) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and for the approximation of the distance from the anterior mitral valve to the interventricular septum (normal less than 1cm) in parasternal long axis (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<a class="elsevierStyleCrossRef" href="#bib0485">43</a> This method should not be considered appropriate in alterations of segmentary contractility.<a class="elsevierStyleCrossRef" href="#bib0495">45</a> The M-mode evaluates systolic function with mitral annular plane systolic excursion (MAPSE) in apical 4-chamber view (normal greater than 15mm) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<a class="elsevierStyleCrossRef" href="#bib0485">43</a> Another method is the calculation of systolic volume (normal 45±13ml) with the Doppler mode and the formula Pi×R2×VTI (velocity time integral) from the left ventricle outflow tract (LVOT), where R is the radius of the LVOT. The VTI is also indicative of systolic function with 18–20cm being normal and less than 12cm considered shock.<a class="elsevierStyleCrossRef" href="#bib0495">45</a><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia>Blood volumeThe systolic obliteration of the left ventricle (kissing papillar muscle sign) can be related to hypovolemia, although other parameters have shown better predictions of volume responsiveness, such as respiratory changes in the diameter of the vena cava (vena cava index, VCI) (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>) and in the maximum velocity of the systolic volume. En patients with invasive mechanical ventilation, inferior VCI greater than 15%<a class="elsevierStyleCrossRef" href="#bib0500">46</a> and a superior VCI greater than 36% is considered to be a volume responder.<a class="elsevierStyleCrossRef" href="#bib0505">47</a> In cases of spontaneous respiration, an adequate correlation with volume responsiveness has not been achieved.<a class="elsevierStyleCrossRef" href="#bib0510">48</a> It has, however, been achieved with values of central venous pressure (CVP), given that inferior VCI>50% with a diameter>2.1cm correlates with CVP<5cm H2O, if it is <50% with diameter>2.1cm it correlates with CVP>10cm H20, and if it does not comply with either, 5–10cm H20.<a class="elsevierStyleCrossRef" href="#bib0515">49</a><elsevierMultimedia ident="fig0030"></elsevierMultimedia>Respiratory changes in the maximum velocity of systolic volume in the LVOT should be greater than 12% to respond to volume (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>).<a class="elsevierStyleCrossRef" href="#bib0520">50</a><elsevierMultimedia ident="fig0035"></elsevierMultimedia>Cardiac tamponadePericardial effusion is identified as a hypoechoic image between the hyperechoic pericardial blades (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>) and later it is determined whether it contributes to the patient's instability. As cardiac tamponade is produced when the pressure inside the pericardium impedes filling during the relaxation phase, diastolic collapse should be searched for initially in the right cavities since they have lower pressure (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>).<a class="elsevierStyleCrossRefs" href="#bib0390">24,51</a> The spectrum of presentation of the tamponade can range from an inward deviation of the atrium to a complete compression of the chamber in diastole.<a class="elsevierStyleCrossRef" href="#bib0525">51</a> In addition, a distended inferior vena cava can be seen as part of the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0390">24</a><elsevierMultimedia ident="fig0040"></elsevierMultimedia><elsevierMultimedia ident="fig0045"></elsevierMultimedia>Right ventricle (RV)Any condition that suddenly increases pulmonary vascular resistance can result in the acute dilation of the RV. The main cause of this condition is pulmonary embolism.<a class="elsevierStyleCrossRef" href="#bib0390">24</a> This event can be observed through the deformation and dilation of the RV, whose normal relationship with the left ventricle is 66%, and this is better observed in apical 4 chamber or parasternal short axis windows (<a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a>).<a class="elsevierStyleCrossRef" href="#bib0515">49</a> Another sign that is indicative of an increase in pressure in the RV is the paradoxical movement of the interventricular septum (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 11</a>).<a class="elsevierStyleCrossRef" href="#bib0390">24</a> Some researchers have reported the sensitivity and specificity of the ultrasound for detecting pulmonary embolism as 55% and 69% respectively<a class="elsevierStyleCrossRef" href="#bib0530">52</a> while in the BLUE protocol, a normal pulmonary examination with evidence of DVT indicates PTE with a sensitivity of 81% and a specificity of 99%.<a class="elsevierStyleCrossRef" href="#bib0410">28</a><elsevierMultimedia ident="fig0050"></elsevierMultimedia><elsevierMultimedia ident="fig0055"></elsevierMultimedia>Right ventricular function can also be assessed in M-mode in the apical 4 chamber window with the tricuspid annular plane systolic excursion (TAPSE) that should be greater than 15mm (<a class="elsevierStyleCrossRef" href="#fig0060">Fig. 12</a>).<a class="elsevierStyleCrossRef" href="#bib0515">49</a> The change on the fractional area (area end diastole – area end systole/area end diastole×100) greater than 35% is indicative of normal systolic function.<a class="elsevierStyleCrossRef" href="#bib0515">49</a><elsevierMultimedia ident="fig0060"></elsevierMultimedia>LungTo rule out pneumothorax, pulmonary edema, consolidation, and pleural effusion in the patient with hypoxemia or shock, we must search for pleural sliding and the A or B lines in the 6 quadrants described in the BLUE protocol as well as signs of pleural effusion.<a class="elsevierStyleCrossRef" href="#bib0410">28</a>To determine the presence of pneumothorax, with the patient in supine, the pleural line is located (the hyperechogenic line between the ribs) between intercostal spaces 3–5 and movement of the 2 blades (pleural sliding) should be absent.<a class="elsevierStyleCrossRef" href="#bib0390">24</a> Sliding should also be observed in M-mode as the “waves on a beach” sign (<a class="elsevierStyleCrossRefs" href="#fig0065">Figs. 13 and 14</a>). In addition, the A lines, which represent horizontal artifacts and are the reflection of the air/tissue interface that causes reverberation between the transductor and the lung, should be searched for. It is key that the A lines be accompanied by an absence of sliding (Profile A′) for a diagnosis of pneumothorax, because these lines can be found in healthy individuals or in patients with COPD or asthma (Profile A).<a class="elsevierStyleCrossRefs" href="#bib0410">28,53,54</a><elsevierMultimedia ident="fig0065"></elsevierMultimedia><elsevierMultimedia ident="fig0070"></elsevierMultimedia>To establish the presence of pulmonary edema, B lines should be identified. These are vertical artifacts of reverberation within the lung that initiate in the pleura toward the bottom of the screen without disappearing and they move with pleural sliding. These B lines with pleural sliding form the interstitial syndrome (Profile B) and are associated with an increase in interstitial water (<a class="elsevierStyleCrossRef" href="#fig0075">Fig. 15</a>).<a class="elsevierStyleCrossRefs" href="#bib0410">28,53,54</a> When no pleural sliding is present, the B lines are associated with pneumonia, atelactasis, or pulmonary contusions (Profile B′).<a class="elsevierStyleCrossRefs" href="#bib0410">28,53,54</a><elsevierMultimedia ident="fig0075"></elsevierMultimedia>Pleural effusion should be searched for in the perisplenic and perihepatic quadrants of EFAST, moving two intercostal spaces in the direction of the head to locate the diaphragm.<a class="elsevierStyleCrossRef" href="#bib0390">24</a> Normally, in the direction of the head from the diaphragmatic cupola there is a reflection of the spleen or the liver (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) while, in the presence of pleural effusion, a hypoechoic image can be observed and the lung compresses giving it the appearance of a solid organ (hepatization) (<a class="elsevierStyleCrossRef" href="#fig0080">Fig. 16</a>).<a class="elsevierStyleCrossRef" href="#bib0390">24</a><elsevierMultimedia ident="fig0080"></elsevierMultimedia>ConclusionUltrasonography is an important tool for diagnosis and managing critical events, for reducing morbidity and mortality and predicting survival in cases of trauma and PEA, reducing complications from invasive procedures, and improving decision-making in cases of cardiac arrest and acute respiratory failure. Ultrasounds performed by non-experts with a minimum of training focused on recognizing specific situations have an adequate correlation with those performed by experts. The variables of evaluation that are most relevant in critical situations in the operating room are left ventricular function, volume responsiveness, cardiac tamponade, and pulmonary evaluation.FundingThe authors did not receive sponsorship to undertake this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres573674" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec590599" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres573675" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec590600" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "What has been the impact of ultrasonography in resuscitation?" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Trauma" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Cardiac arrest and shock" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Predicting survival" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Acute respiratory failure" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Invasive procedures" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "What does a non-expert need to train themselves and how reliable is it?" ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "How to perform and evaluation with echography in resuscitation?" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Left ventricular systolic function" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Blood volume" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Cardiac tamponade" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Right ventricle (RV)" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Lung" ] ] ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-10" "fechaAceptado" => "2015-03-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec590599" "palabras" => array:5 [ 0 => "Ultrasonics" 1 => "Cardiopulmonary resuscitation" 2 => "Cardiac tamponade" 3 => "Stroke volume" 4 => "Ventricular dysfunction, Right" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec590600" "palabras" => array:5 [ 0 => "Ultrasonido" 1 => "Resucitación cardiopulmonar" 2 => "Taponamiento Cardíaco" 3 => "Volumen Sistólico" 4 => "Disfunción ventricular Derecha" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Ultrasound has become a diagnostic and therapeutic tool for critical situations. This article reviews the development of ultrasound with respect to critical events and its impact on reducing morbidity and mortality from abdominal and chest trauma, on the recognition of reversible causes of pulseless electrical activity, on decision-making in acute respiratory failure, and on predicting survival and reducing complications associated with invasive procedures. We revised how ultrasounds performed by non-experts with a minimum of training and focused on recognizing specific situations have a good degree of correlation with expert conducted ultrasounds. Some protocols of ultrasound in resuscitation described in the literature are reviewed and a description is made of the most relevant variables in critical situations, including left ventricular function, volume responsiveness, cardiac tamponade, right ventricular dilatation, and pulmonary evaluation." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El ultrasonido se ha convertido en una herramienta diagnóstica y terapéutica en situaciones críticas. Este artículo revisa la evolución del ultrasonido en eventos críticos y su impacto a través de la disminución de morbimortalidad en trauma abdominal y torácico, en el reconocimiento de causas reversibles en actividad eléctrica sin pulso, en la toma de decisiones en falla ventilatoria aguda, en predicción de supervivencia y en la disminución de complicaciones en procedimientos invasivos. Se revisa cómo el ultrasonido realizado por no expertos con mínimo entrenamiento enfocado al reconocimiento de situaciones específicas tiene una adecuada correlación con el experto. Se revisan algunos protocolos de ultrasonido en reanimación descritos en la literatura y se hace una descripción de las variables más relevantes en situaciones críticas como la función ventricular izquierda, respuesta a volumen, taponamiento cardíaco, dilatación del ventrículo derecho y la evaluación pulmonar." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pérez-Coronado JD, Franco-Gruntorad GA. Utilidad del Ultrasonido en Reanimación. Rev Colomb Anestesiol. 2015;43:321–330." ] ] "multimedia" => array:16 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2223 "Ancho" => 2500 "Tamanyo" => 387909 ] ] "descripcion" => array:1 [ "en" => "View of the 4 Ps of FAST. A, Pericardial in the subxiphoid 4 chamber window. Observe that there is no fluid between H, the anterior blade of the pericardium (arrow) and the right ventricle. B, Perihepatic in the upper right quadrant of the abdomen. Observe the Morrison pouch (arrow) between H and R with an absence of fluid. C, Perisplenic in the upper left quandrant of the abdomen. Observe the absence of fluid (arrow) between B and R. Also observe the normal reflection of the spleen above the diaphragm (RB). D, Pelvic. Observe the most anterior hypoechoic image that corresponds to the bladder (V) and the more posterior free fluid (arrow). VI: left ventricle, VD: right ventricle, H: liver, D: diaphragm, B: spleen, R: kidney." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1228 "Ancho" => 917 "Tamanyo" => 92800 ] ] "descripcion" => array:1 [ "en" => "Upper right quadrant in FAST. Observe the hypoechoic image (arrow) that separates the kidney (R) from the liver. This is compatible with intra-abdominal free fluid." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1101 "Ancho" => 1658 "Tamanyo" => 210557 ] ] "descripcion" => array:1 [ "en" => "Parasternal long axis window in M-mode. Shortening fraction=[DM−Dm/DM]×100. Normal value greater than 25%. DM: greatest diameter (blue line 1), DM: Smallest Diameter (blue line 2)." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1106 "Ancho" => 1658 "Tamanyo" => 254985 ] ] "descripcion" => array:1 [ "en" => "Parasternal long axis window in M-mode. Distance from anterior mitral valve to interventricular septum (blue line 0.7cm). Normal value less than 1cm." ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1108 "Ancho" => 1658 "Tamanyo" => 245432 ] ] "descripcion" => array:1 [ "en" => "Apical 4-chamber window in M-mode. Mitral annular plane systolic excursion or MAPSE (blue line 1.42cm). Normal value greater than 1cm." ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1108 "Ancho" => 1658 "Tamanyo" => 213730 ] ] "descripcion" => array:1 [ "en" => "Subxiphoid window of inferior vena cava in M-mode. Inferior vena cava index=(DM−Dm/DM)×100. DM: Greatest Diameter (blue line), DM: Smallest Diameter (green line). During mechanical ventilation, a value greater than 15% is considered to be a volume responder. In spontaneous ventilation, a value >50% with diameter<2.1cm correlates with CVP<5cm H2O. If it is <50% with diameter>2.1cm, it correlates with CVP>10cm H20. If it has diameter<2.1cm with value <50%, or diameter>2.1cm with value >50%, it correlates with CVP between 5 and 10cmH2O." ] ] 6 => array:8 [ "identificador" => "fig0035" "etiqueta" => "Fig. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1388 "Ancho" => 1658 "Tamanyo" => 178502 ] ] "descripcion" => array:1 [ "en" => "Apical 5-chamber window. Pulsed Doppler in the left ventricle outflow tract (LVOT) (red arrow). Variability of maximum velocity of the systolic volume in the LVOT (blue numbers) greater than 12% is related to volume responsiveness." ] ] 7 => array:8 [ "identificador" => "fig0040" "etiqueta" => "Fig. 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1117 "Ancho" => 3250 "Tamanyo" => 182644 ] ] "descripcion" => array:1 [ "en" => "Parasternal long axis window. (A) Normal; (B) Severe pericardial effusion (arrows). VD: Right Ventricle, VI: Left Ventricle, AI: Left Atrium, VA: Aortic Valve, PP: Posterior Pericardium, AD: Descending Thoracic Aorta." ] ] 8 => array:8 [ "identificador" => "fig0045" "etiqueta" => "Fig. 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 1212 "Ancho" => 1658 "Tamanyo" => 145709 ] ] "descripcion" => array:1 [ "en" => "Apical 4-chamber window showing cardiac tamponade. Observe the severe pericardial effusion (DP) and the compression on the right chambers (arrows). VD: Right Ventricle, VI: Left Ventricle, AD: Right Atrium, AI: Left Atrium." ] ] 9 => array:8 [ "identificador" => "fig0050" "etiqueta" => "Fig. 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 1302 "Ancho" => 1658 "Tamanyo" => 112116 ] ] "descripcion" => array:1 [ "en" => "Apical 4-chamber window. The relationship between the VD and the VI should not be greater than 66%. Note how the VD is larger than the VI. CIA: Atrial Septal Defect." ] ] 10 => array:8 [ "identificador" => "fig0055" "etiqueta" => "Fig. 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 1100 "Ancho" => 2788 "Tamanyo" => 201242 ] ] "descripcion" => array:1 [ "en" => "(A) Parasternal short axis window. Observe the noral relationship between the VD and the VI; (B) Flattening of SIV (arrow) during systole or paradoxical movement makes the VI take the form of D and indicates pressure overload. Also observe the increase in the size of the VD as compared to the VI. VD: Right Ventricle, VI: Left Ventricle, SIV: Interventricular Septum (IVS)." ] ] 11 => array:8 [ "identificador" => "fig0060" "etiqueta" => "Fig. 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 1102 "Ancho" => 1658 "Tamanyo" => 175848 ] ] "descripcion" => array:1 [ "en" => "Apical 4-chamber window in M-mode. Tricuspid annular plane systolic excursion (TAPSE) (blue line). Normal value greater than 1.5cm." ] ] 12 => array:8 [ "identificador" => "fig0065" "etiqueta" => "Fig. 13" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr13.jpeg" "Alto" => 1070 "Ancho" => 1660 "Tamanyo" => 168782 ] ] "descripcion" => array:1 [ "en" => "Zone 1 pulmonary (anterior) in intercostal spaces 3–5. The pleura is seen as a hyperechoic line (arrow) between the ribs (C), which are hypoechoic." ] ] 13 => array:8 [ "identificador" => "fig0070" "etiqueta" => "Fig. 14" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr14.jpeg" "Alto" => 1160 "Ancho" => 3250 "Tamanyo" => 320749 ] ] "descripcion" => array:1 [ "en" => "(A) Pleural sliding observed in M-mode as “waves on the beach” sign. The thoracic wall that is not moving represents the waves (O) and the pleural sliding represents the beach (P); (B) M-mode with stratosphere sign. Represents all the non-mobile structures (E)." ] ] 14 => array:8 [ "identificador" => "fig0075" "etiqueta" => "Fig. 15" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr15.jpeg" "Alto" => 1100 "Ancho" => 1658 "Tamanyo" => 89160 ] ] "descripcion" => array:1 [ "en" => "The interstitial syndrome is characterized by the presence of pleural sliding and artifacts. B. Observe the presence of more than 3 vertical lines (B) that begin in the pleura and go to the bottom of the screen, related with pulmonary edema." ] ] 15 => array:8 [ "identificador" => "fig0080" "etiqueta" => "Fig. 16" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr16.jpeg" "Alto" => 1120 "Ancho" => 1658 "Tamanyo" => 115358 ] ] "descripcion" => array:1 [ "en" => "Upper left quadrant of EFAST. Observe a hypoechoic zone in the supradiaphragmatic zone that indicates the presence of liquid (L) and the hepatization of the lung, giving it the appearance of a solid organ (H). D: Diaphragm." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:54 [ 0 => array:3 [ "identificador" => "bib0275" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac function determined by echocardiogram" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Shors" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "1975" "volumen" => "3" "paginaInicial" => "5" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1126178" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0280" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.F. Armstrong" 1 => "B.F. Schilt" 2 => "D.J. Helper" 3 => "J.C. Dillo" 4 => "H. Feigenbaum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1982" "volumen" => "65" "paginaInicial" => "1491" "paginaFinal" => "1496" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7074806" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0285" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immediate diagnosis of acute myocardial infarction by two dimensional echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.S. Horowitz" 1 => "J. Morganroth" 2 => "C. Parrotto" 3 => "C.C. Chen" 4 => "J. Soffer" 5 => "F.J. Pauletto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1982" "volumen" => "65" "paginaInicial" => "323" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7053890" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0290" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.L.A. Reichert" 1 => "C.A. Visser" 2 => "J.J. Koolen" 3 => "R.B. vd Brink" 4 => "H.B. van Wezel" 5 => "N.G. Meyne" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1992" "volumen" => "104" "paginaInicial" => "321" "paginaFinal" => "326" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1495293" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0295" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Vieillard-Baron" 1 => "S. Prin" 2 => "K. Chergui" 3 => "O. Dubourg" 4 => "F. Jardin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200306-816CC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2003" "volumen" => "168" "paginaInicial" => "1270" "paginaFinal" => "1276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14644922" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0300" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of transesophageal echocardiography in the diagnosis and management of traumatic aortic disruption" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Vignon" 1 => "P. Guéret" 2 => "J.M. Vedrinne" 3 => "P. Lagrange" 4 => "E. Cornu" 5 => "O. Abrieu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1995" "volumen" => "92" "paginaInicial" => "2959" "paginaFinal" => "2968" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7586266" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0305" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonography versus peritoneal lavage in blunt abdominal trauma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Gruessner" 1 => "B. Mentges" 2 => "C. Düber" 3 => "K. Rückert" 4 => "M. Rothmund" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "1989" "volumen" => "29" "paginaInicial" => "242" "paginaFinal" => "244" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2645411" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0310" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonography in blunt abdominal trauma: a preliminary progress report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Tso" 1 => "A. Rodriguez" 2 => "C. Cooper" 3 => "P. Militello" 4 => "S. Mirvis" 5 => "M.M. Badellino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "1992" "volumen" => "33" "paginaInicial" => "39" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1635104" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0315" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective study of surgeon performed ultrasound as the primary adjuvant modality for injured patient assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.S. Rozycki" 1 => "M.G. Ochsner" 2 => "J.A. Schmidt" 3 => "H.L. Frankel" 4 => "T.P. Davis" 5 => "D. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "1995" "volumen" => "39" "paginaInicial" => "492" "paginaFinal" => "498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7473914" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0320" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focused assessment with sonography for trauma (FAST): results from an international consensus conference" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.M. Scalea" 1 => "A. Rodriguez" 2 => "W.C. Chiu" 3 => "F.D. Brenneman" 4 => "W.F. Fallon Jr." 5 => "K. Kato" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "1999" "volumen" => "46" "paginaInicial" => "466" "paginaFinal" => "472" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10088853" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0325" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective evaluation of thoracic ultrasound in the detection of pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Dulchavsky" 1 => "K.L. Schawarz" 2 => "A.W. Kirkpatrick" 3 => "R.D. Billica" 4 => "D.R. Williams" 5 => "L.N. Diebel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "2001" "volumen" => "50" "paginaInicial" => "201" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11242282" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0330" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid detection of traumatic effusion using surgeon performed ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.C. Sisley" 1 => "G.S. Rozycki" 2 => "R.B. Ballard" 3 => "N. Namias" 4 => "J.P. Salomone" 5 => "D.V. Feliciano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "1998" "volumen" => "44" "paginaInicial" => "291" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9498500" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0335" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transesophageal pulsed Doppler echocardiography of pulmonary venous flow to assess left ventricular filling pressure in ventilated patients with acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Vargas" 1 => "D. Gruson" 2 => "R. Valentino" 3 => "H.N. Bui" 4 => "L.R. Salmi" 5 => "V. Gilleron" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Crit Care" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "187" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15484180" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0340" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Echo-Doppler demonstration of acute cor pulmonale in the medical intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Vieillard-Baron" 1 => "S. Prin" 2 => "K. Chergui" 3 => "O. Dubourg" 4 => "F. Jardin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200202-146CC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2002" "volumen" => "166" "paginaInicial" => "1310" "paginaFinal" => "1319" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12421740" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0345" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Institute for Clinical Excellence. Guideline on the use of ultrasound location devices for placing central venous catheters. London, 2002." ] ] ] 15 => array:3 [ "identificador" => "bib0350" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.W. Neumar" 1 => "C.W. Otto" 2 => "M.S. Link" 3 => "S.L. Kronick" 4 => "M. Shuster" 5 => "C.W. Callaway" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.970988" "Revista" => array:7 [ "tituloSerie" => "Circulation" "fecha" => "2010" "volumen" => "122" "numero" => "Suppl 3" "paginaInicial" => "S729" "paginaFinal" => "S767" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956224" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0355" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beyond focused assessment with sonography for trauma: ultrasound creep in the trauma resuscitation area and, beyond" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Matsushima" 1 => "H.L. Frankel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0b013e32834be582" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "606" "paginaFinal" => "612" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21934613" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0360" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.W. Kirkpatrick" 1 => "M. Sirois" 2 => "K.B. Laupland" 3 => "D. Liu" 4 => "K. Rowan" 5 => "C.G. Ball" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "2004" "volumen" => "57" "paginaInicial" => "288" "paginaFinal" => "295" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15345974" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0365" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The occult pneumothorax: what have we learned?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.G. Ball" 1 => "A.W. Kirkpatrick" 2 => "D.V. Feliciano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Surg" "fecha" => "2009" "volumen" => "52" "paginaInicial" => "E173" "paginaFinal" => "E179" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19865549" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0370" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, risk factors and outcomes for occult pneumothoraces in victims of major trauma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.G. Ball" 1 => "A.W. Kirkpatrick" 2 => "K.B. Laupland" 3 => "D.I. Fox" 4 => "S. Nicolaou" 5 => "I.B. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "2005" "volumen" => "59" "paginaInicial" => "917" "paginaFinal" => "924" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16374282" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0375" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trauma ultrasound examination versus chest radiography in the detection of hemothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O.J. Ma" 1 => "J.R. Mateer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "1997" "volumen" => "29" "paginaInicial" => "312" "paginaFinal" => "315" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9055768" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0380" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemothorax after a stab wound to the chest, with clear breath sounds and a normal radiograph" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Reardon" 1 => "S. Joing" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1197/j.aem.2006.05.010" "Revista" => array:5 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2006" "volumen" => "13" "paginaInicial" => "786" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16816094" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0385" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Echocardiography in cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Price" 1 => "S. Uddin" 2 => "K.B. Laupland" 3 => "T. Quinn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0b013e3283399d4c" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "211" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20463464" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0390" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The RUSH Exam: rapid ultrasound in shock in the evaluation of the critically III" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Perera" 1 => "T. Mailhot" 2 => "D. Riley" 3 => "D. Mandavia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.emc.2009.09.010" "Revista" => array:6 [ "tituloSerie" => "Emerg Med Clin North Am" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "29" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19945597" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0395" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point of care cardiac ultrasound applications in the emergency department and intensive care unit–a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.T. Arntfield" 1 => "S.J. Millington" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Cardiol Rev" "fecha" => "2012" "volumen" => "8" "paginaInicial" => "98" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22894759" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0400" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hand-carried ultrasound performed by hospitalist: does it improve the cardiac physical examination?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Martin" 1 => "E.E. Howell" 2 => "R.C. Ziegelstein" 3 => "C. Martire" 4 => "Q.E. Whiting-O’Keefe" 5 => "E.P. Shapiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2008.07.022" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2009" "volumen" => "122" "paginaInicial" => "35" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19114170" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0405" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Emergency Ultrasound Working Group of the Johann Wolfgang Goethe-University Hospital, Frankfurt am Main" "etal" => true "autores" => array:6 [ 0 => "R. Breitkreutz" 1 => "S. Price" 2 => "H.V. Steiger" 3 => "F.H. Seeger" 4 => "H. Ilper" 5 => "H. Ackermann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2010.07.013" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2010" "volumen" => "81" "paginaInicial" => "1527" "paginaFinal" => "1533" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20801576" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0410" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Blyth" 1 => "P. Atkinson" 2 => "K. Gadd" 3 => "E. Lang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1553-2712.2012.01456.x" "Revista" => array:6 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2012" "volumen" => "19" "paginaInicial" => "1119" "paginaFinal" => "1126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23039118" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0415" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.L. Cureton" 1 => "L.Y. Yeung" 2 => "R.O. Kwan" 3 => "E.J. Miraflor" 4 => "J. Sadjadi" 5 => "D.D. Price" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Trauma Acute Care Surg" "fecha" => "2012" "volumen" => "73" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0420" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.A. Lichtenstein" 1 => "G.A. Mezière" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.07-2800" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2008" "volumen" => "134" "paginaInicial" => "117" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18403664" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0425" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Zanobetti" 1 => "C. Poggioni" 2 => "R. Pini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.10-0435" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2011" "volumen" => "139" "paginaInicial" => "1140" "paginaFinal" => "1147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20947649" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0430" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preventing complications of central venous catheterization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. McGee" 1 => "M.K. Gould" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra011883" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "348" "paginaInicial" => "1123" "paginaFinal" => "1133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12646670" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0435" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central vascular catheter placement evaluation using saline flush and bedside echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Weekes" 1 => "D.A. Johnson" 2 => "S.M. Keller" 3 => "B. Efune" 4 => "C. Carey" 5 => "N.L. Rozario" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/acem.12283" "Revista" => array:7 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2014" "volumen" => "21" "paginaInicial" => "65" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24552526" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2213260014701535" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0440" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "British Thoracic Society. Pleural disease guideline 2010. A quick reference guide." ] ] ] 34 => array:3 [ "identificador" => "bib0445" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Procedural applications of ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.D. Tibbles" 1 => "W. Porcaro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.emc.2004.04.010" "Revista" => array:7 [ "tituloSerie" => "Emerg Med Clin North Am" "fecha" => "2004" "volumen" => "22" "paginaInicial" => "797" "paginaFinal" => "815" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15301851" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508514002194" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0450" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hand-carried cardiac ultrasound (HCU) device: recommendations regarding new, technology. A report from the echocardiography task force on new technology of the Nomenclature and Standards Committee of the American Society of Echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.B. Seward" 1 => "P.S. Douglas" 2 => "R. Erbel" 3 => "R.E. Kerber" 4 => "I. Kronzon" 5 => "H. Rakowski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2002" "volumen" => "15" "paginaInicial" => "369" "paginaFinal" => "373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11944016" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0455" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Ultrasonido en emergencias y trauma (USET)" "serieFecha" => "2007" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0460" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American College of Chest Physicians/La Societé de Réanimation de Langue Française statement on competence in critical care ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.H. Mayo" 1 => "Y. Beaulieu" 2 => "P. Doelken" 3 => "D. Feller-Kopman" 4 => "C. Harrod" 5 => "A. Kaplan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-2305" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2009" "volumen" => "135" "paginaInicial" => "1050" "paginaFinal" => "1060" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19188546" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0465" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International expert statement on training standards for critical care ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Expert Round Table on Ultrasound in ICU" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-011-2246-9" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1077" "paginaFinal" => "1083" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21614639" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0470" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid cardiac ultrasound of inpatients suffering PEA performed by nonexpert sonographers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Niendorff" 1 => "A.J. Rassias" 2 => "R. Palac" 3 => "M.L. Beach" 4 => "S. Costa" 5 => "M. Greenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2005.04.007" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2005" "volumen" => "67" "paginaInicial" => "81" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16199290" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0475" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Feasibility and reliability of point of care pocket-size echocardiography performed by medical residents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "O.C. Mjølstad" 1 => "G.N. Andersen" 2 => "H. Dalen" 3 => "T. Graven" 4 => "K. Skjetne" 5 => "J.O. Kleinau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ehjci/jet062" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J Cardiovasc Imaging" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "1195" "paginaFinal" => "1202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23644936" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0480" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.J. Labovitz" 1 => "V.E. Noble" 2 => "M. Bierig" 3 => "S.A. Goldstein" 4 => "R. Jones" 5 => "S. Kort" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.echo.2010.10.005" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2010" "volumen" => "23" "paginaInicial" => "1225" "paginaFinal" => "1230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21111923" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0485" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transthoracic echocardiography for cardiopulmonary monitoring in intensive care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.B. Jensen" 1 => "E. Sloth" 2 => "K.M. Larsen" 3 => "M.D. Schmidt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2004" "volumen" => "21" "paginaInicial" => "700" "paginaFinal" => "707" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15595582" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0490" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Echocardiography in the ICU: time for widespread use!" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.P. Cholley" 1 => "A. Vieillard-Baron" 2 => "A. Mebazaa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-005-2833-8" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2006" "volumen" => "32" "paginaInicial" => "9" "paginaFinal" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16292627" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0495" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Echocardiographic hemodynamic monitoring in the critically ill patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F.J. Romero-Bermejo" 1 => "M. Ruiz-Bailen" 2 => "M. Guerrero-De-Mier" 3 => "J. Lopez-Alvaro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Cardiol Rev" "fecha" => "2011" "volumen" => "7" "paginaInicial" => "146" "paginaFinal" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22758613" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0500" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Barbier" 1 => "Y. Loubières" 2 => "C. Schmit" 3 => "J. Hayon" 4 => "J.L. Ricôme" 5 => "F. Jardin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-004-2259-8" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2004" "volumen" => "30" "paginaInicial" => "1740" "paginaFinal" => "1746" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15034650" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0505" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Vieillard" 1 => "K. Chergui" 2 => "A. Rabiller" 3 => "O. Peyrouset" 4 => "B. Page" 5 => "A. Beauchet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-004-2361-y" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2004" "volumen" => "30" "paginaInicial" => "1734" "paginaFinal" => "1739" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15375649" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0510" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Muller" 1 => "X. Bobbia" 2 => "M. Toumi" 3 => "G. Louart" 4 => "N. Molinari" 5 => "B. Ragonnet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc11672" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2012" "volumen" => "16" "paginaInicial" => "R188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23043910" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0515" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Rudski" 1 => "W.W. Lai" 2 => "J. Afilalo" 3 => "L. Hua" 4 => "M.D. Handschumacher" 5 => "K. Chandrasekaran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.echo.2010.05.010" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2010" "volumen" => "23" "paginaInicial" => "685" "paginaFinal" => "713" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20620859" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0520" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Slama" 1 => "H. Masson" 2 => "J.L. Teboul" 3 => "M.L. Arnout" 4 => "D. Susic" 5 => "E. Frohkich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Physiol Heart Circ Physiol" "fecha" => "2002" "volumen" => "283" "paginaInicial" => "1729" "paginaFinal" => "1733" ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0525" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pericardial effusion: haemodynamic spectrum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Shabetai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2004" "volumen" => "90" "paginaInicial" => "255" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14966038" "web" => "Medline" ] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0530" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Triage patients with suspected pulmonary embolism in the emergency department using a portable ultrasound device" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Mansencal" 1 => "A. Vileillard-Baron" 2 => "A. Beauchet" 3 => "J.C. Farcot" 4 => "M. El Hajjam" 5 => "G. Dufaitre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8175.2007.00623.x" "Revista" => array:6 [ "tituloSerie" => "Echocardiography" "fecha" => "2008" "volumen" => "25" "paginaInicial" => "451" "paginaFinal" => "456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18452470" "web" => "Medline" ] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0535" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound(ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Volpicelli" 1 => "M. Elbarbary" 2 => "M. Blaivas" 3 => "D.A. Lichtenstein" 4 => "G. Mathis" 5 => "A.W. Kirkpatrick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2513-4" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "577" "paginaFinal" => "591" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22392031" "web" => "Medline" ] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0540" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound in the critically ill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Lichtenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0000000000000096" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "315" "paginaFinal" => "322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24758984" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000371/v1_201510250024/en/main.assets" "Apartado" => array:4 [ "identificador" => "34050" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004300000004/v1_201510250024/S2256208715000371/v1_201510250024/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000371?idApp=UINPBA00004N"]

Statistics

Review

Utility of ultrasound in resuscitation

Utilidad del Ultrasonido en Reanimación

Juan David Pérez-Coronadoa,

Corresponding author

perezjuand@hotmail.com

Corresponding author at: Calle 163a Número 13B - 60. Segundo Piso Torre A. Fundación Cardioinfantil Instituto de Cardiología. Bogotá, Colombia.

, Germán Andrés Franco-Gruntoradb

a Resident in Anesthesiology, Fundación Cardioinfantil, Bogotá, Colombia

b Cardiovascular Anesthesiologist, Fundación Cardioinfantil, Bogotá, Colombia

Read

5977

Times
was read the article

855

Total PDF

5122

Total HTML

Share statistics

 array:24 [
  "pii" => "S2256208715000371"
  "issn" => "22562087"
  "doi" => "10.1016/j.rcae.2015.05.001"
  "estado" => "S300"
  "fechaPublicacion" => "2015-10-01"
  "aid" => "219"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "ssu"
  "cita" => "Rev Colomb Anestesiol. 2015;43:321-30"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2529
    "formatos" => array:3 [
      "EPUB" => 94
      "HTML" => 2046
      "PDF" => 389
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S012033471500043X"
      "issn" => "01203347"
      "doi" => "10.1016/j.rca.2015.03.011"
      "estado" => "S300"
      "fechaPublicacion" => "2015-10-01"
      "aid" => "219"
      "copyright" => "Sociedad Colombiana de Anestesiolog&#237;a y Reanimaci&#243;n"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "ssu"
      "cita" => "Rev Colomb Anestesiol. 2015;43:321-30"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4864
        "formatos" => array:3 [
          "EPUB" => 107
          "HTML" => 3755
          "PDF" => 1002
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "Utilidad de la ecograf&#237;a en reanimaci&#243;n"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "321"
            "paginaFinal" => "330"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Utility of ultrasound in resuscitation"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0080"
            "etiqueta" => "Figura 16"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr16.jpeg"
                "Alto" => 1120
                "Ancho" => 1658
                "Tamanyo" => 115358
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Cuadrante superior izquierdo del EFAST&#46; Observe en el espacio supradiafragm&#225;tico una zona hipoecoica indicativa de l&#237;quido &#40;L&#41; y la hepatizaci&#243;n del pulm&#243;n d&#225;ndole apariencia de &#243;rgano s&#243;lido &#40;H&#41;&#46; D&#58; Diafragma&#46;</p> <p id="spar0170" class="elsevierStyleSimplePara elsevierViewall">Fuente&#58; autores&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan David P&#233;rez-Coronado, Germ&#225;n Andr&#233;s Franco-Gruntorad"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Juan David"
                "apellidos" => "P&#233;rez-Coronado"
              ]
              1 => array:2 [
                "nombre" => "Germ&#225;n Andr&#233;s"
                "apellidos" => "Franco-Gruntorad"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2256208715000371"
          "doi" => "10.1016/j.rcae.2015.05.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000371?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S012033471500043X?idApp=UINPBA00004N"
      "url" => "/01203347/0000004300000004/v1_201510300044/S012033471500043X/v1_201510300044/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2256208715000565"
    "issn" => "22562087"
    "doi" => "10.1016/j.rcae.2015.06.005"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "229"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "ssu"
    "cita" => "Rev Colomb Anestesiol. 2015;43:331-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2273
      "formatos" => array:3 [
        "EPUB" => 111
        "HTML" => 1720
        "PDF" => 442
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Ergonomics in ultrasound-guided nerve blocks"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "331"
          "paginaFinal" => "339"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ergonom&#237;a en los bloqueos nerviosos guiados por ultrasonograf&#237;a"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1794
              "Ancho" => 2437
              "Tamanyo" => 189831
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; &#40;along the visual axis&#41; and &#40;B&#41; &#40;across the visual axis&#41;&#58; monitor&#44; transducer&#44; needle and operator orientation in relation to the visual axis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Oscar David Aguirre-Ospina, Juli&#225;n Felipe Gonz&#225;lez-Maldonado, &#193;ngela Mar&#237;a R&#237;os-Medina"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Oscar David"
              "apellidos" => "Aguirre-Ospina"
            ]
            1 => array:2 [
              "nombre" => "Juli&#225;n Felipe"
              "apellidos" => "Gonz&#225;lez-Maldonado"
            ]
            2 => array:2 [
              "nombre" => "&#193;ngela Mar&#237;a"
              "apellidos" => "R&#237;os-Medina"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0120334715000714"
        "doi" => "10.1016/j.rca.2015.06.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715000714?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000565?idApp=UINPBA00004N"
    "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000565/v1_201510250024/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2256208715000346"
    "issn" => "22562087"
    "doi" => "10.1016/j.rcae.2015.04.006"
    "estado" => "S300"
    "fechaPublicacion" => "2015-10-01"
    "aid" => "216"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "ssu"
    "cita" => "Rev Colomb Anestesiol. 2015;43:314-20"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2179
      "formatos" => array:3 [
        "EPUB" => 92
        "HTML" => 1770
        "PDF" => 317
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Ultrasound applications in the central nervous system for neuroanaesthesia and neurocritical care"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "314"
          "paginaFinal" => "320"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Aplicaciones de la ultrasonograf&#237;a en el sistema nervioso central para Neuroanestesia y cuidado neurocr&#237;tico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 993
              "Ancho" => 2666
              "Tamanyo" => 190551
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Visualization of the structures in a patient through the temporal bone window&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Source&#58; authors&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Lucas Ochoa-P&#233;rez, Alejandro Cardozo-Ocampo"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Lucas"
              "apellidos" => "Ochoa-P&#233;rez"
            ]
            1 => array:2 [
              "nombre" => "Alejandro"
              "apellidos" => "Cardozo-Ocampo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0120334715000404"
        "doi" => "10.1016/j.rca.2015.03.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715000404?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000346?idApp=UINPBA00004N"
    "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000346/v1_201510250024/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "Utility of ultrasound in resuscitation"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "321"
        "paginaFinal" => "330"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juan David P&#233;rez-Coronado, Germ&#225;n Andr&#233;s Franco-Gruntorad"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Juan David"
            "apellidos" => "P&#233;rez-Coronado"
            "email" => array:1 [
              0 => "perezjuand&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Germ&#225;n Andr&#233;s"
            "apellidos" => "Franco-Gruntorad"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Resident in Anesthesiology&#44; Fundaci&#243;n Cardioinfantil&#44; Bogot&#225;&#44; Colombia"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cardiovascular Anesthesiologist&#44; Fundaci&#243;n Cardioinfantil&#44; Bogot&#225;&#44; Colombia"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>&#58; Calle 163a N&#250;mero 13B - 60&#46; Segundo Piso Torre A&#46; Fundaci&#243;n Cardioinfantil Instituto de Cardiolog&#237;a&#46; Bogot&#225;&#44; Colombia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Utilidad del Ultrasonido en Reanimaci&#243;n"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0060"
        "etiqueta" => "Fig&#46; 12"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr12.jpeg"
            "Alto" => 1102
            "Ancho" => 1658
            "Tamanyo" => 175848
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Apical 4-chamber window in M-mode&#46; Tricuspid annular plane systolic excursion &#40;TAPSE&#41; &#40;blue line&#41;&#46; Normal value greater than 1&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ultrasound technology has become one of the most useful diagnostic and therapeutic tools of our time&#46; Since leaving the exclusive domain of radiologists and being used by Emergency and Intensive Care Unit &#40;ICU&#41; departments&#44; the ultrasound has arrived in the operating room and is now a tool for perioperative care&#44; regional anesthetics&#44; and vascular access&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the 1970s&#44; the use of echocardiography in the ICU was limited to evaluating systolic volume and cardiac output&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">1</span></a> In the 1980s and 1990s&#44; it quickly developed to aid in the identification of acute events like cardiac tamponade&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">2</span></a> complications from myocardial infarction&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">3</span></a> hemodynamic assessments in cases of hypotension&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a> sepsis&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">5</span></a> and the detection of ruptured aortic aneurisms&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In trauma&#44; the use of the ultrasound began in 1980 in Europe and Japan&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">7</span></a> In 1992&#44; it was used in the USA to detect hemoperitoneum in cases of closed abdominal trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">8</span></a> Rozycki and collaborators demonstrated the effectiveness of ultrasonography in detecting pericardial effusion and intraperitoneal fluid with 81&#37; sensitivity and 99&#37; specificity&#46; They described it with the acronym &#8220;FAST&#8221; &#40;Focused Abdominal Sonography for Trauma&#41; for evaluating abdominal trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a> In 1997&#44; through international consensus&#44; the &#8216;A&#8217; was changed from &#8220;Abdominal&#8221; to &#8220;Assessment&#8221; and it was included in ATLS&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">10</span></a> In addition&#44; there are a great quantity of studies on the utility of ultrasonography in other scenarios such as pneumothorax&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">11</span></a> hemothorax&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a> and vascular accesses&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Thanks to these descriptions&#44; many algorithms for the use of ultrasounds in resuscitation have been published &#40;FATE&#44; CAUSE&#44; RUSH&#41;&#44; and&#44; in 2004&#44; the American College of Emergency Physicians &#40;ACEP&#41; considered that bedside ultrasonography should be integrated into routine practice&#46; In 2010&#44; the American Heart Association guides for advanced life support recommend echocardiography for diagnosing treatable causes of cardiac arrest where defibrillation is impossible and to orient treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">What has been the impact of ultrasonography in resuscitation&#63;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Its impact can be seen in the reduction of morbidity and mortality from trauma&#44; the recognition of potentially reversible causes of non-shockable cardiac arrest and shock&#44; the prediction of survival&#44; in decision-making in cases of acute respiratory failure&#44; and in the reduction of complications from invasive procedures&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Trauma</span><p id="par0030" class="elsevierStylePara elsevierViewall">FAST consists of the evaluation of four points &#40;pericardial&#44; perihepatic&#44; perisplenic&#44; and pelvic &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#41; to detect hypoechoic images related to free pericardial and intra-abdominal fluids of up to 100<span class="elsevierStyleHsp" style=""></span>ml &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; with a sensitivity of 50&#8211;88&#37;&#46; Its application has managed to reduce mortality from cardiac and abdominal trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> Its extended application to the thorax &#40;EFAST&#41; for detecting pneumothorax and hemothorax has been very important&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">18</span></a> Firstly this is because it is more sensitive than radiography techniques for diagnosing pneumothorax &#40;48&#37; vs&#46; 20&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a> a pathology that is calculated to be hidden in 5&#37; of all traumas<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">19</span></a> and in up to 55&#37; of severe traumas&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">20</span></a> Secondly&#44; echography may detect fluid with a volume of 20<span class="elsevierStyleHsp" style=""></span>ml while radiography detects 200<span class="elsevierStyleHsp" style=""></span>ml&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">21</span></a> Thus&#44; echography has a superior sensitivity and specificity when it comes to detecting hemothorax&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">22</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Cardiac arrest and shock</span><p id="par0035" class="elsevierStylePara elsevierViewall">Survival for Pulseless Electric Activity &#40;PEA&#41; and asystole is much less than for other cardiac arrest rhythms&#46; This is probably due to the fact that they depend on the correct identification and rapid treatment of underlying causes&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">16</span></a> Of these causes&#44; only hypoxemia&#44; hypothermia&#44; and hypo&#47;hyperkalemia are easily diagnosed&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">23</span></a> Furthermore&#44; only 45&#37; of physicians correctly diagnose a lack of pulse in cardiac arrest without differentiating between PEA and pseudo PEA&#46; This may lead to physicians not treating a reversible cause&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">23</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In shock&#44; morbidity and mortality also depend on the duration and the rapid treatment of the cause&#46; However&#44; the clinical differentiation between hypovolemic&#44; distributive&#44; cardiogenic&#44; or obstructive shock cannot always be correctly performed<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">24</span></a> since the physical examination detects only 57&#37; of cardiac anomalies&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">25</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Ultrasonography plays an important role in these non-shockable cardiac arrest and shock scenarios since it allows physicians to rapidly exclude potentially reversible causes of cardiogenic shock&#44; hypovolemia&#44; cardiac tamponade&#44; pneumothorax&#44; and hemothorax&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">23&#8211;25</span></a> Moreover&#44; it increases the exactness of the cardiac physical examination by 60&#8211;90&#37; for pericardial effusion&#44; left ventricular function&#44; and cardiomegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">26</span></a> It also helps to differentiate a pseudo PEA from a true one so that behavior can be changed in up to 78&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Predicting survival</span><p id="par0050" class="elsevierStylePara elsevierViewall">Ultrasonography has been suggested as a tool for ceasing resuscitation since&#44; when there is no evidence of myocardial contractility&#44; the probability of return of spontaneous circulation is 3&#37; in cases of PEA<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a> and the probability of survival is 2&#37; in cases of trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Acute respiratory failure</span><p id="par0055" class="elsevierStylePara elsevierViewall">Proper decision-making in this scenario was documented in 2008 with the BLUE protocol&#44; an observational study that evaluated criteria like pleural sliding and the consolidation and presence of A or B lines in 3 zones of the thorax called&#58; zone 1 &#40;anterior&#41;&#44; zone 2 &#40;lateral&#41;&#44; and zone 3 &#40;postero-lateral&#41;&#46; Each of these zones is halved to create a total of 6 investigation areas&#46; Based on these findings&#44; 6 profiles were established &#40;A&#44; A&#8242;&#44; B&#44; B&#8242;&#44; AB&#44; C&#41; that&#44; compared to the final diagnosis&#44; had a sensitivity and specificity of greater than 80&#37; and 90&#37; respectively for detecting COPD&#44; asthma&#44; pneumothorax&#44; pulmonary edema&#44; pneumonia&#44; and pulmonary thromboembolism&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">30</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In addition&#44; echography has a high concordance with radiography in various acute pulmonary pathologies &#40;effusions&#44; consolidation&#44; edema&#41; and can be performed in less time&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">31</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Invasive procedures</span><p id="par0065" class="elsevierStylePara elsevierViewall">When inserting a central venous catheter &#40;CVC&#41;&#44; ultrasonography reduced mechanical complications and insertion time&#44; especially in the internal jugular&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">32</span></a> Furthermore&#44; it determines the correct placement of the point of the CVC with a sensitivity of 70&#37; and a specificity of 100&#37; with the saline flush test&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">33</span></a> In cases of thoracentesis&#44; ultrasound increases the probability of success and reduces the risk of organ puncture&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">34</span></a> For pericardiocentesis&#44; the incidence of complications drops 50&#8211;4&#46;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">35</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">What does a non-expert need to train themselves and how reliable is it&#63;</span><p id="par0070" class="elsevierStylePara elsevierViewall">The American Society of Echocardiography &#40;ASE&#41; determines that the main use of portable ultrasound is to extend the exactitude of the physical examination&#46; It should be objective-guided&#46; For this to take place&#44; at least a basic level of training&#44; including performing 75 examinations and interpreting 150&#44; is required&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">36</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The Council of Emergency Medicine Residency Directors recommends that Emergency training programs include 2<span class="elsevierStyleHsp" style=""></span>weeks&#47;80<span class="elsevierStyleHsp" style=""></span>h of training and 150 evaluations in critical situations&#44; including 40 FAST examinations&#44; 30 deep vein thrombosis &#40;DVT&#41; examinations&#44; and 10 procedure examinations&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Intensive care programs recommend training in general concepts that include the pleura&#44; thorax&#44; vascular system&#44; and abdomen in addition to basic echocardiography to recognize blood volume&#44; biventricular function&#44; cardiac tamponade&#44; and severe acute valve failure&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">38</span></a> 10<span class="elsevierStyleHsp" style=""></span>h of theoretical training in each module and 30 trans-thoracic echocardiograms are recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Several studies have shown the correlation of non-expert personnel and expert personnel in specific situations&#46; Niendorff et al&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">40</span></a> evaluated residents that received training in the subcostal window for recognizing cardiac tamponade&#44; pulmonary embolism&#44; hypovolemia&#44; and reduction in contractility with a concordance in 80&#37; over 7<span class="elsevierStyleHsp" style=""></span>min in PEA scenarios&#46; Another study&#44; performed on residents and involving 100 cases found a strong correlation in terms of the evaluation of left ventricular function&#44; and pleural&#44; pericardial and moderate effusion to quantify vena cava and valve failure in 6<span class="elsevierStyleHsp" style=""></span>min&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">41</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">How to perform and evaluation with echography in resuscitation&#63;</span><p id="par0090" class="elsevierStylePara elsevierViewall">There are many protocols described in the literature that include echocardiography&#44; EFAST&#44; the lung&#44; the aorta&#44; the vena cava&#44; DVT&#44; and ectopic pregnancy&#44; etc&#46; For example&#44; the consensus from the ACEP on echocardiograms at the patient&#39;s bedside is focused on pericardial effusion&#44; systolic function&#44; right ventricular growth&#44; intravascular volume&#44; and on confirming transvenous pacemakers&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">42</span></a> The FATE protocol &#40;Focus Assessed Transthoracic Echocardiographic&#41; focuses its evaluation on pericardial effusion&#44; the thickness and dimensions of the heart chambers&#44; contractility&#44; and on the pleura&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a> The RUSH &#40;Rapid Ultrasound in Shock&#41; protocol establishes a standpoint for differentiating between hypovolemic&#44; cardiogenic&#44; distributive&#44; and obstructive shock based on 3 variables&#58; &#40;1&#41; The pump &#40;pericardial effusion&#44; left ventricular contractility&#44; and dilation of the right ventricle&#41;&#44; &#40;2&#41; the tank &#40;inferior vena cava for hypovolemia&#44; EFAST or pulmonary edema to evaluate leaks and pneumothorax for compression&#41;&#44; and &#40;3&#41; the pipes &#40;aortic aneurism and DVT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">24</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Of these variables we must choose the most relevant ones for evaluating critical events in operating rooms such as shock with unclear etiology&#44; cardiorespiratory arrest with non-shockable rhythms&#44; and hypoxemia&#46; The evaluation should be organized and directed depending on the clinical situation and should include&#58; left ventricular function to rule out myocardial dysfunction&#44; volume responsiveness to evaluate hypovolemia&#44; pericardial effusion for cardiac tamponade&#44; dilation of the right ventricle for pulmonary embolism&#44; and pulmonary ultrasound to rule out pneumothorax&#44; hemothorax&#44; and pulmonary edema&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Left ventricular systolic function</span><p id="par0100" class="elsevierStylePara elsevierViewall">Contractility can be evaluated qualitatively and quickly through the thickening of the endocardium to differentiate between normal and severe dysfunction&#46; This approach is useful for determining the presence of cardiogenic shock and for guiding the use of inotropic&#47;vasopressor medications or intravenous fluids&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">44</span></a> The standard quantitative evaluation is the calculation of the ejection fraction using Simpson&#39;s method&#46; However&#44; this requires 2 planes &#40;apical 4-chamber and 2-chamber&#41; and an advanced calculation that is not always available in these scenarios&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a> The M-mode &#40;movement in time&#41; is a more simple method used in the FATE protocol&#46; It allows for the calculation of the shortening fraction &#40;normal greater than 25&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; and for the approximation of the distance from the anterior mitral valve to the interventricular septum &#40;normal less than 1<span class="elsevierStyleHsp" style=""></span>cm&#41; in parasternal long axis &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a> This method should not be considered appropriate in alterations of segmentary contractility&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a> The M-mode evaluates systolic function with mitral annular plane systolic excursion &#40;MAPSE&#41; in apical 4-chamber view &#40;normal greater than 15<span class="elsevierStyleHsp" style=""></span>mm&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a> Another method is the calculation of systolic volume &#40;normal 45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>ml&#41; with the Doppler mode and the formula Pi<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>VTI &#40;velocity time integral&#41; from the left ventricle outflow tract &#40;LVOT&#41;&#44; where <span class="elsevierStyleItalic">R</span> is the radius of the LVOT&#46; The VTI is also indicative of systolic function with 18&#8211;20<span class="elsevierStyleHsp" style=""></span>cm being normal and less than 12<span class="elsevierStyleHsp" style=""></span>cm considered shock&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Blood volume</span><p id="par0105" class="elsevierStylePara elsevierViewall">The systolic obliteration of the left ventricle &#40;kissing papillar muscle sign&#41; can be related to hypovolemia&#44; although other parameters have shown better predictions of volume responsiveness&#44; such as respiratory changes in the diameter of the vena cava &#40;vena cava index&#44; VCI&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41; and in the maximum velocity of the systolic volume&#46; En patients with invasive mechanical ventilation&#44; inferior VCI greater than 15&#37;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">46</span></a> and a superior VCI greater than 36&#37; is considered to be a volume responder&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a> In cases of spontaneous respiration&#44; an adequate correlation with volume responsiveness has not been achieved&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">48</span></a> It has&#44; however&#44; been achieved with values of central venous pressure &#40;CVP&#41;&#44; given that inferior VCI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>50&#37; with a diameter<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;1<span class="elsevierStyleHsp" style=""></span>cm correlates with CVP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O&#44; if it is &#60;50&#37; with diameter<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;1<span class="elsevierStyleHsp" style=""></span>cm it correlates with CVP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>0&#44; and if it does not comply with either&#44; 5&#8211;10<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>0&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a></p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Respiratory changes in the maximum velocity of systolic volume in the LVOT should be greater than 12&#37; to respond to volume &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">50</span></a></p><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Cardiac tamponade</span><p id="par0115" class="elsevierStylePara elsevierViewall">Pericardial effusion is identified as a hypoechoic image between the hyperechoic pericardial blades &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41; and later it is determined whether it contributes to the patient&#39;s instability&#46; As cardiac tamponade is produced when the pressure inside the pericardium impedes filling during the relaxation phase&#44; diastolic collapse should be searched for initially in the right cavities since they have lower pressure &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">24&#44;51</span></a> The spectrum of presentation of the tamponade can range from an inward deviation of the atrium to a complete compression of the chamber in diastole&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">51</span></a> In addition&#44; a distended inferior vena cava can be seen as part of the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">24</span></a></p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><elsevierMultimedia ident="fig0045"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Right ventricle &#40;RV&#41;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Any condition that suddenly increases pulmonary vascular resistance can result in the acute dilation of the RV&#46; The main cause of this condition is pulmonary embolism&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">24</span></a> This event can be observed through the deformation and dilation of the RV&#44; whose normal relationship with the left ventricle is 66&#37;&#44; and this is better observed in apical 4 chamber or parasternal short axis windows &#40;<a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a> Another sign that is indicative of an increase in pressure in the RV is the paradoxical movement of the interventricular septum &#40;<a class="elsevierStyleCrossRef" href="#fig0055">Fig&#46; 11</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">24</span></a> Some researchers have reported the sensitivity and specificity of the ultrasound for detecting pulmonary embolism as 55&#37; and 69&#37; respectively<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">52</span></a> while in the BLUE protocol&#44; a normal pulmonary examination with evidence of DVT indicates PTE with a sensitivity of 81&#37; and a specificity of 99&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a></p><elsevierMultimedia ident="fig0050"></elsevierMultimedia><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Right ventricular function can also be assessed in M-mode in the apical 4 chamber window with the tricuspid annular plane systolic excursion &#40;TAPSE&#41; that should be greater than 15<span class="elsevierStyleHsp" style=""></span>mm &#40;<a class="elsevierStyleCrossRef" href="#fig0060">Fig&#46; 12</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a> The change on the fractional area &#40;area end diastole &#8211; area end systole&#47;area end diastole<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41; greater than 35&#37; is indicative of normal systolic function&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a></p><elsevierMultimedia ident="fig0060"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Lung</span><p id="par0130" class="elsevierStylePara elsevierViewall">To rule out pneumothorax&#44; pulmonary edema&#44; consolidation&#44; and pleural effusion in the patient with hypoxemia or shock&#44; we must search for pleural sliding and the A or B lines in the 6 quadrants described in the BLUE protocol as well as signs of pleural effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">To determine the presence of pneumothorax&#44; with the patient in supine&#44; the pleural line is located &#40;the hyperechogenic line between the ribs&#41; between intercostal spaces 3&#8211;5 and movement of the 2 blades &#40;pleural sliding&#41; should be absent&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">24</span></a> Sliding should also be observed in M-mode as the &#8220;waves on a beach&#8221; sign &#40;<a class="elsevierStyleCrossRefs" href="#fig0065">Figs&#46; 13 and 14</a>&#41;&#46; In addition&#44; the A lines&#44; which represent horizontal artifacts and are the reflection of the air&#47;tissue interface that causes reverberation between the transductor and the lung&#44; should be searched for&#46; It is key that the A lines be accompanied by an absence of sliding &#40;Profile A&#8242;&#41; for a diagnosis of pneumothorax&#44; because these lines can be found in healthy individuals or in patients with COPD or asthma &#40;Profile A&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">28&#44;53&#44;54</span></a></p><elsevierMultimedia ident="fig0065"></elsevierMultimedia><elsevierMultimedia ident="fig0070"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">To establish the presence of pulmonary edema&#44; B lines should be identified&#46; These are vertical artifacts of reverberation within the lung that initiate in the pleura toward the bottom of the screen without disappearing and they move with pleural sliding&#46; These B lines with pleural sliding form the interstitial syndrome &#40;Profile B&#41; and are associated with an increase in interstitial water &#40;<a class="elsevierStyleCrossRef" href="#fig0075">Fig&#46; 15</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">28&#44;53&#44;54</span></a> When no pleural sliding is present&#44; the B lines are associated with pneumonia&#44; atelactasis&#44; or pulmonary contusions &#40;Profile B&#8242;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">28&#44;53&#44;54</span></a></p><elsevierMultimedia ident="fig0075"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Pleural effusion should be searched for in the perisplenic and perihepatic quadrants of EFAST&#44; moving two intercostal spaces in the direction of the head to locate the diaphragm&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">24</span></a> Normally&#44; in the direction of the head from the diaphragmatic cupola there is a reflection of the spleen or the liver &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41; while&#44; in the presence of pleural effusion&#44; a hypoechoic image can be observed and the lung compresses giving it the appearance of a solid organ &#40;hepatization&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0080">Fig&#46; 16</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">24</span></a></p><elsevierMultimedia ident="fig0080"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0150" class="elsevierStylePara elsevierViewall">Ultrasonography is an important tool for diagnosis and managing critical events&#44; for reducing morbidity and mortality and predicting survival in cases of trauma and PEA&#44; reducing complications from invasive procedures&#44; and improving decision-making in cases of cardiac arrest and acute respiratory failure&#46; Ultrasounds performed by non-experts with a minimum of training focused on recognizing specific situations have an adequate correlation with those performed by experts&#46; The variables of evaluation that are most relevant in critical situations in the operating room are left ventricular function&#44; volume responsiveness&#44; cardiac tamponade&#44; and pulmonary evaluation&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors did not receive sponsorship to undertake this article&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres573674"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec590599"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres573675"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec590600"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "What has been the impact of ultrasonography in resuscitation&#63;"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Trauma"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Cardiac arrest and shock"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Predicting survival"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Acute respiratory failure"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Invasive procedures"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "What does a non-expert need to train themselves and how reliable is it&#63;"
        ]
        7 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "How to perform and evaluation with echography in resuscitation&#63;"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Left ventricular systolic function"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Blood volume"
            ]
            2 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Cardiac tamponade"
            ]
            3 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Right ventricle &#40;RV&#41;"
            ]
            4 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Lung"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-09-10"
    "fechaAceptado" => "2015-03-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec590599"
          "palabras" => array:5 [
            0 => "Ultrasonics"
            1 => "Cardiopulmonary resuscitation"
            2 => "Cardiac tamponade"
            3 => "Stroke volume"
            4 => "Ventricular dysfunction&#44; Right"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec590600"
          "palabras" => array:5 [
            0 => "Ultrasonido"
            1 => "Resucitaci&#243;n cardiopulmonar"
            2 => "Taponamiento Card&#237;aco"
            3 => "Volumen Sist&#243;lico"
            4 => "Disfunci&#243;n ventricular Derecha"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasound has become a diagnostic and therapeutic tool for critical situations&#46; This article reviews the development of ultrasound with respect to critical events and its impact on reducing morbidity and mortality from abdominal and chest trauma&#44; on the recognition of reversible causes of pulseless electrical activity&#44; on decision-making in acute respiratory failure&#44; and on predicting survival and reducing complications associated with invasive procedures&#46; We revised how ultrasounds performed by non-experts with a minimum of training and focused on recognizing specific situations have a good degree of correlation with expert conducted ultrasounds&#46; Some protocols of ultrasound in resuscitation described in the literature are reviewed and a description is made of the most relevant variables in critical situations&#44; including left ventricular function&#44; volume responsiveness&#44; cardiac tamponade&#44; right ventricular dilatation&#44; and pulmonary evaluation&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El ultrasonido se ha convertido en una herramienta diagn&#243;stica y terap&#233;utica en situaciones cr&#237;ticas&#46; Este art&#237;culo revisa la evoluci&#243;n del ultrasonido en eventos cr&#237;ticos y su impacto a trav&#233;s de la disminuci&#243;n de morbimortalidad en trauma abdominal y tor&#225;cico&#44; en el reconocimiento de causas reversibles en actividad el&#233;ctrica sin pulso&#44; en la toma de decisiones en falla ventilatoria aguda&#44; en predicci&#243;n de supervivencia y en la disminuci&#243;n de complicaciones en procedimientos invasivos&#46; Se revisa c&#243;mo el ultrasonido realizado por no expertos con m&#237;nimo entrenamiento enfocado al reconocimiento de situaciones espec&#237;ficas tiene una adecuada correlaci&#243;n con el experto&#46; Se revisan algunos protocolos de ultrasonido en reanimaci&#243;n descritos en la literatura y se hace una descripci&#243;n de las variables m&#225;s relevantes en situaciones cr&#237;ticas como la funci&#243;n ventricular izquierda&#44; respuesta a volumen&#44; taponamiento card&#237;aco&#44; dilataci&#243;n del ventr&#237;culo derecho y la evaluaci&#243;n pulmonar&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez-Coronado JD&#44; Franco-Gruntorad GA&#46; Utilidad del Ultrasonido en Reanimaci&#243;n&#46; Rev Colomb Anestesiol&#46; 2015&#59;43&#58;321&#8211;330&#46;</p>"
      ]
    ]
    "multimedia" => array:16 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2223
            "Ancho" => 2500
            "Tamanyo" => 387909
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">View of the 4 Ps of FAST&#46; A&#44; <span class="elsevierStyleItalic">Pericardial</span> in the subxiphoid 4 chamber window&#46; Observe that there is no fluid between H&#44; the anterior blade of the pericardium &#40;arrow&#41; and the right ventricle&#46; B&#44; <span class="elsevierStyleItalic">Perihepatic</span> in the upper right quadrant of the abdomen&#46; Observe the Morrison pouch &#40;arrow&#41; between H and R with an absence of fluid&#46; C&#44; <span class="elsevierStyleItalic">Perisplenic</span> in the upper left quandrant of the abdomen&#46; Observe the absence of fluid &#40;arrow&#41; between B and R&#46; Also observe the normal reflection of the spleen above the diaphragm &#40;RB&#41;&#46; D&#44; <span class="elsevierStyleItalic">Pelvic</span>&#46; Observe the most anterior hypoechoic image that corresponds to the bladder &#40;V&#41; and the more posterior free fluid &#40;arrow&#41;&#46; VI&#58; left ventricle&#44; VD&#58; right ventricle&#44; H&#58; liver&#44; D&#58; diaphragm&#44; B&#58; spleen&#44; R&#58; kidney&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1228
            "Ancho" => 917
            "Tamanyo" => 92800
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Upper right quadrant in FAST&#46; Observe the hypoechoic image &#40;arrow&#41; that separates the kidney &#40;R&#41; from the liver&#46; This is compatible with intra-abdominal free fluid&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1101
            "Ancho" => 1658
            "Tamanyo" => 210557
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Parasternal long axis window in M-mode&#46; Shortening fraction<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#91;DM<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Dm&#47;DM&#93;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#46; Normal value greater than 25&#37;&#46; DM&#58; greatest diameter &#40;blue line 1&#41;&#44; DM&#58; Smallest Diameter &#40;blue line 2&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1106
            "Ancho" => 1658
            "Tamanyo" => 254985
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Parasternal long axis window in M-mode&#46; Distance from anterior mitral valve to interventricular septum &#40;blue line 0&#46;7<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46; Normal value less than 1<span class="elsevierStyleHsp" style=""></span>cm&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Fig&#46; 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1108
            "Ancho" => 1658
            "Tamanyo" => 245432
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Apical 4-chamber window in M-mode&#46; Mitral annular plane systolic excursion or MAPSE &#40;blue line 1&#46;42<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46; Normal value greater than 1<span class="elsevierStyleHsp" style=""></span>cm&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig0030"
        "etiqueta" => "Fig&#46; 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 1108
            "Ancho" => 1658
            "Tamanyo" => 213730
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Subxiphoid window of inferior vena cava in M-mode&#46; Inferior vena cava index<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#40;DM<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Dm&#47;DM&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#46; DM&#58; Greatest Diameter &#40;blue line&#41;&#44; DM&#58; Smallest Diameter &#40;green line&#41;&#46; During mechanical ventilation&#44; a value greater than 15&#37; is considered to be a volume responder&#46; In spontaneous ventilation&#44; a value &#62;50&#37; with diameter<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;1<span class="elsevierStyleHsp" style=""></span>cm correlates with CVP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O&#46; If it is &#60;50&#37; with diameter<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;1<span class="elsevierStyleHsp" style=""></span>cm&#44; it correlates with CVP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm H20&#46; If it has diameter<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;1<span class="elsevierStyleHsp" style=""></span>cm with value &#60;50&#37;&#44; or diameter<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;1<span class="elsevierStyleHsp" style=""></span>cm with value &#62;50&#37;&#44; it correlates with CVP between 5 and 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig0035"
        "etiqueta" => "Fig&#46; 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1388
            "Ancho" => 1658
            "Tamanyo" => 178502
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Apical 5-chamber window&#46; Pulsed Doppler in the left ventricle outflow tract &#40;LVOT&#41; &#40;red arrow&#41;&#46; Variability of maximum velocity of the systolic volume in the LVOT &#40;blue numbers&#41; greater than 12&#37; is related to volume responsiveness&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig0040"
        "etiqueta" => "Fig&#46; 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1117
            "Ancho" => 3250
            "Tamanyo" => 182644
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Parasternal long axis window&#46; &#40;A&#41; Normal&#59; &#40;B&#41; Severe pericardial effusion &#40;arrows&#41;&#46; VD&#58; Right Ventricle&#44; VI&#58; Left Ventricle&#44; AI&#58; Left Atrium&#44; VA&#58; Aortic Valve&#44; PP&#58; Posterior Pericardium&#44; AD&#58; Descending Thoracic Aorta&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "fig0045"
        "etiqueta" => "Fig&#46; 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr9.jpeg"
            "Alto" => 1212
            "Ancho" => 1658
            "Tamanyo" => 145709
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Apical 4-chamber window showing cardiac tamponade&#46; Observe the severe pericardial effusion &#40;DP&#41; and the compression on the right chambers &#40;arrows&#41;&#46; VD&#58; Right Ventricle&#44; VI&#58; Left Ventricle&#44; AD&#58; Right Atrium&#44; AI&#58; Left Atrium&#46;</p>"
        ]
      ]
      9 => array:8 [
        "identificador" => "fig0050"
        "etiqueta" => "Fig&#46; 10"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr10.jpeg"
            "Alto" => 1302
            "Ancho" => 1658
            "Tamanyo" => 112116
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Apical 4-chamber window&#46; The relationship between the VD and the VI should not be greater than 66&#37;&#46; Note how the VD is larger than the VI&#46; CIA&#58; Atrial Septal Defect&#46;</p>"
        ]
      ]
      10 => array:8 [
        "identificador" => "fig0055"
        "etiqueta" => "Fig&#46; 11"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr11.jpeg"
            "Alto" => 1100
            "Ancho" => 2788
            "Tamanyo" => 201242
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Parasternal short axis window&#46; Observe the noral relationship between the VD and the VI&#59; &#40;B&#41; Flattening of SIV &#40;arrow&#41; during systole or paradoxical movement makes the VI take the form of D and indicates pressure overload&#46; Also observe the increase in the size of the VD as compared to the VI&#46; VD&#58; Right Ventricle&#44; VI&#58; Left Ventricle&#44; SIV&#58; Interventricular Septum &#40;IVS&#41;&#46;</p>"
        ]
      ]
      11 => array:8 [
        "identificador" => "fig0060"
        "etiqueta" => "Fig&#46; 12"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr12.jpeg"
            "Alto" => 1102
            "Ancho" => 1658
            "Tamanyo" => 175848
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Apical 4-chamber window in M-mode&#46; Tricuspid annular plane systolic excursion &#40;TAPSE&#41; &#40;blue line&#41;&#46; Normal value greater than 1&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46;</p>"
        ]
      ]
      12 => array:8 [
        "identificador" => "fig0065"
        "etiqueta" => "Fig&#46; 13"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr13.jpeg"
            "Alto" => 1070
            "Ancho" => 1660
            "Tamanyo" => 168782
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Zone 1 pulmonary &#40;anterior&#41; in intercostal spaces 3&#8211;5&#46; The pleura is seen as a hyperechoic line &#40;arrow&#41; between the ribs &#40;C&#41;&#44; which are hypoechoic&#46;</p>"
        ]
      ]
      13 => array:8 [
        "identificador" => "fig0070"
        "etiqueta" => "Fig&#46; 14"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr14.jpeg"
            "Alto" => 1160
            "Ancho" => 3250
            "Tamanyo" => 320749
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Pleural sliding observed in M-mode as &#8220;waves on the beach&#8221; sign&#46; The thoracic wall that is not moving represents the waves &#40;O&#41; and the pleural sliding represents the beach &#40;P&#41;&#59; &#40;B&#41; M-mode with stratosphere sign&#46; Represents all the non-mobile structures &#40;E&#41;&#46;</p>"
        ]
      ]
      14 => array:8 [
        "identificador" => "fig0075"
        "etiqueta" => "Fig&#46; 15"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr15.jpeg"
            "Alto" => 1100
            "Ancho" => 1658
            "Tamanyo" => 89160
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The interstitial syndrome is characterized by the presence of pleural sliding and artifacts&#46; B&#46; Observe the presence of more than 3 vertical lines &#40;B&#41; that begin in the pleura and go to the bottom of the screen&#44; related with pulmonary edema&#46;</p>"
        ]
      ]
      15 => array:8 [
        "identificador" => "fig0080"
        "etiqueta" => "Fig&#46; 16"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; Authors&#46;"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr16.jpeg"
            "Alto" => 1120
            "Ancho" => 1658
            "Tamanyo" => 115358
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Upper left quadrant of EFAST&#46; Observe a hypoechoic zone in the supradiaphragmatic zone that indicates the presence of liquid &#40;L&#41; and the hepatization of the lung&#44; giving it the appearance of a solid organ &#40;H&#41;&#46; D&#58; Diaphragm&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:54 [
            0 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac function determined by echocardiogram"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Shors"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1975"
                        "volumen" => "3"
                        "paginaInicial" => "5"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1126178"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diastolic collapse of the right ventricle with cardiac tamponade&#58; an echocardiographic study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46;F&#46; Armstrong"
                            1 => "B&#46;F&#46; Schilt"
                            2 => "D&#46;J&#46; Helper"
                            3 => "J&#46;C&#46; Dillo"
                            4 => "H&#46; Feigenbaum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1982"
                        "volumen" => "65"
                        "paginaInicial" => "1491"
                        "paginaFinal" => "1496"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7074806"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immediate diagnosis of acute myocardial infarction by two dimensional echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;S&#46; Horowitz"
                            1 => "J&#46; Morganroth"
                            2 => "C&#46; Parrotto"
                            3 => "C&#46;C&#46; Chen"
                            4 => "J&#46; Soffer"
                            5 => "F&#46;J&#46; Pauletto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1982"
                        "volumen" => "65"
                        "paginaInicial" => "323"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7053890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transesophageal echocardiography in hypotensive patients after cardiac operations&#46; Comparison with hemodynamic parameters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;L&#46;A&#46; Reichert"
                            1 => "C&#46;A&#46; Visser"
                            2 => "J&#46;J&#46; Koolen"
                            3 => "R&#46;B&#46; vd Brink"
                            4 => "H&#46;B&#46; van Wezel"
                            5 => "N&#46;G&#46; Meyne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "1992"
                        "volumen" => "104"
                        "paginaInicial" => "321"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1495293"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemodynamic instability in sepsis&#58; bedside assessment by Doppler echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Vieillard-Baron"
                            1 => "S&#46; Prin"
                            2 => "K&#46; Chergui"
                            3 => "O&#46; Dubourg"
                            4 => "F&#46; Jardin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200306-816CC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "168"
                        "paginaInicial" => "1270"
                        "paginaFinal" => "1276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14644922"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of transesophageal echocardiography in the diagnosis and management of traumatic aortic disruption"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Vignon"
                            1 => "P&#46; Gu&#233;ret"
                            2 => "J&#46;M&#46; Vedrinne"
                            3 => "P&#46; Lagrange"
                            4 => "E&#46; Cornu"
                            5 => "O&#46; Abrieu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1995"
                        "volumen" => "92"
                        "paginaInicial" => "2959"
                        "paginaFinal" => "2968"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7586266"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sonography versus peritoneal lavage in blunt abdominal trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Gruessner"
                            1 => "B&#46; Mentges"
                            2 => "C&#46; D&#252;ber"
                            3 => "K&#46; R&#252;ckert"
                            4 => "M&#46; Rothmund"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1989"
                        "volumen" => "29"
                        "paginaInicial" => "242"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2645411"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sonography in blunt abdominal trauma&#58; a preliminary progress report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Tso"
                            1 => "A&#46; Rodriguez"
                            2 => "C&#46; Cooper"
                            3 => "P&#46; Militello"
                            4 => "S&#46; Mirvis"
                            5 => "M&#46;M&#46; Badellino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1992"
                        "volumen" => "33"
                        "paginaInicial" => "39"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1635104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective study of surgeon performed ultrasound as the primary adjuvant modality for injured patient assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;S&#46; Rozycki"
                            1 => "M&#46;G&#46; Ochsner"
                            2 => "J&#46;A&#46; Schmidt"
                            3 => "H&#46;L&#46; Frankel"
                            4 => "T&#46;P&#46; Davis"
                            5 => "D&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1995"
                        "volumen" => "39"
                        "paginaInicial" => "492"
                        "paginaFinal" => "498"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7473914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focused assessment with sonography for trauma &#40;FAST&#41;&#58; results from an international consensus conference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;M&#46; Scalea"
                            1 => "A&#46; Rodriguez"
                            2 => "W&#46;C&#46; Chiu"
                            3 => "F&#46;D&#46; Brenneman"
                            4 => "W&#46;F&#46; Fallon Jr&#46;"
                            5 => "K&#46; Kato"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1999"
                        "volumen" => "46"
                        "paginaInicial" => "466"
                        "paginaFinal" => "472"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10088853"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective evaluation of thoracic ultrasound in the detection of pneumothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Dulchavsky"
                            1 => "K&#46;L&#46; Schawarz"
                            2 => "A&#46;W&#46; Kirkpatrick"
                            3 => "R&#46;D&#46; Billica"
                            4 => "D&#46;R&#46; Williams"
                            5 => "L&#46;N&#46; Diebel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2001"
                        "volumen" => "50"
                        "paginaInicial" => "201"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11242282"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid detection of traumatic effusion using surgeon performed ultrasonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;C&#46; Sisley"
                            1 => "G&#46;S&#46; Rozycki"
                            2 => "R&#46;B&#46; Ballard"
                            3 => "N&#46; Namias"
                            4 => "J&#46;P&#46; Salomone"
                            5 => "D&#46;V&#46; Feliciano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1998"
                        "volumen" => "44"
                        "paginaInicial" => "291"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9498500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transesophageal pulsed Doppler echocardiography of pulmonary venous flow to assess left ventricular filling pressure in ventilated patients with acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Vargas"
                            1 => "D&#46; Gruson"
                            2 => "R&#46; Valentino"
                            3 => "H&#46;N&#46; Bui"
                            4 => "L&#46;R&#46; Salmi"
                            5 => "V&#46; Gilleron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "187"
                        "paginaFinal" => "197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15484180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Echo-Doppler demonstration of acute cor pulmonale in the medical intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Vieillard-Baron"
                            1 => "S&#46; Prin"
                            2 => "K&#46; Chergui"
                            3 => "O&#46; Dubourg"
                            4 => "F&#46; Jardin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200202-146CC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "1310"
                        "paginaFinal" => "1319"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12421740"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "National Institute for Clinical Excellence&#46; Guideline on the use of ultrasound location devices for placing central venous catheters&#46; London&#44; 2002&#46;"
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Part 8&#58; adult advanced cardiovascular life support&#58; 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;W&#46; Neumar"
                            1 => "C&#46;W&#46; Otto"
                            2 => "M&#46;S&#46; Link"
                            3 => "S&#46;L&#46; Kronick"
                            4 => "M&#46; Shuster"
                            5 => "C&#46;W&#46; Callaway"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.970988"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "122"
                        "numero" => "Suppl 3"
                        "paginaInicial" => "S729"
                        "paginaFinal" => "S767"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beyond focused assessment with sonography for trauma&#58; ultrasound creep in the trauma resuscitation area and&#44; beyond"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Matsushima"
                            1 => "H&#46;L&#46; Frankel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCC.0b013e32834be582"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "606"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21934613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hand-held thoracic sonography for detecting post-traumatic pneumothoraces&#58; the Extended Focused Assessment with Sonography for Trauma &#40;EFAST&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;W&#46; Kirkpatrick"
                            1 => "M&#46; Sirois"
                            2 => "K&#46;B&#46; Laupland"
                            3 => "D&#46; Liu"
                            4 => "K&#46; Rowan"
                            5 => "C&#46;G&#46; Ball"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2004"
                        "volumen" => "57"
                        "paginaInicial" => "288"
                        "paginaFinal" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15345974"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The occult pneumothorax&#58; what have we learned&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;G&#46; Ball"
                            1 => "A&#46;W&#46; Kirkpatrick"
                            2 => "D&#46;V&#46; Feliciano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Surg"
                        "fecha" => "2009"
                        "volumen" => "52"
                        "paginaInicial" => "E173"
                        "paginaFinal" => "E179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19865549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; risk factors and outcomes for occult pneumothoraces in victims of major trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;G&#46; Ball"
                            1 => "A&#46;W&#46; Kirkpatrick"
                            2 => "K&#46;B&#46; Laupland"
                            3 => "D&#46;I&#46; Fox"
                            4 => "S&#46; Nicolaou"
                            5 => "I&#46;B&#46; Anderson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2005"
                        "volumen" => "59"
                        "paginaInicial" => "917"
                        "paginaFinal" => "924"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16374282"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trauma ultrasound examination versus chest radiography in the detection of hemothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "O&#46;J&#46; Ma"
                            1 => "J&#46;R&#46; Mateer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "1997"
                        "volumen" => "29"
                        "paginaInicial" => "312"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9055768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemothorax after a stab wound to the chest&#44; with clear breath sounds and a normal radiograph"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Reardon"
                            1 => "S&#46; Joing"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1197/j.aem.2006.05.010"
                      "Revista" => array:5 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2006"
                        "volumen" => "13"
                        "paginaInicial" => "786"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16816094"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Echocardiography in cardiac arrest"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Price"
                            1 => "S&#46; Uddin"
                            2 => "K&#46;B&#46; Laupland"
                            3 => "T&#46; Quinn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCC.0b013e3283399d4c"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "211"
                        "paginaFinal" => "215"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20463464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The RUSH Exam&#58; rapid ultrasound in shock in the evaluation of the critically III"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Perera"
                            1 => "T&#46; Mailhot"
                            2 => "D&#46; Riley"
                            3 => "D&#46; Mandavia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.emc.2009.09.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med Clin North Am"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "29"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19945597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point of care cardiac ultrasound applications in the emergency department and intensive care unit&#8211;a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;T&#46; Arntfield"
                            1 => "S&#46;J&#46; Millington"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Cardiol Rev"
                        "fecha" => "2012"
                        "volumen" => "8"
                        "paginaInicial" => "98"
                        "paginaFinal" => "108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22894759"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hand-carried ultrasound performed by hospitalist&#58; does it improve the cardiac physical examination&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Martin"
                            1 => "E&#46;E&#46; Howell"
                            2 => "R&#46;C&#46; Ziegelstein"
                            3 => "C&#46; Martire"
                            4 => "Q&#46;E&#46; Whiting-O&#8217;Keefe"
                            5 => "E&#46;P&#46; Shapiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2008.07.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2009"
                        "volumen" => "122"
                        "paginaInicial" => "35"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19114170"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients&#58; a prospective trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Emergency Ultrasound Working Group of the Johann Wolfgang Goethe-University Hospital&#44; Frankfurt am Main"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Breitkreutz"
                            1 => "S&#46; Price"
                            2 => "H&#46;V&#46; Steiger"
                            3 => "F&#46;H&#46; Seeger"
                            4 => "H&#46; Ilper"
                            5 => "H&#46; Ackermann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.resuscitation.2010.07.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Resuscitation"
                        "fecha" => "2010"
                        "volumen" => "81"
                        "paginaInicial" => "1527"
                        "paginaFinal" => "1533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20801576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bedside focused echocardiography as predictor of survival in cardiac arrest patients&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Blyth"
                            1 => "P&#46; Atkinson"
                            2 => "K&#46; Gadd"
                            3 => "E&#46; Lang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1553-2712.2012.01456.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "1119"
                        "paginaFinal" => "1126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23039118"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The heart of the matter&#58; utility of ultrasound of cardiac activity during traumatic arrest"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;L&#46; Cureton"
                            1 => "L&#46;Y&#46; Yeung"
                            2 => "R&#46;O&#46; Kwan"
                            3 => "E&#46;J&#46; Miraflor"
                            4 => "J&#46; Sadjadi"
                            5 => "D&#46;D&#46; Price"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "J Trauma Acute Care Surg"
                        "fecha" => "2012"
                        "volumen" => "73"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relevance of lung ultrasound in the diagnosis of acute respiratory failure&#58; the BLUE protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;A&#46; Lichtenstein"
                            1 => "G&#46;A&#46; Mezi&#232;re"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.07-2800"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2008"
                        "volumen" => "134"
                        "paginaInicial" => "117"
                        "paginaFinal" => "125"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18403664"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Zanobetti"
                            1 => "C&#46; Poggioni"
                            2 => "R&#46; Pini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-0435"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2011"
                        "volumen" => "139"
                        "paginaInicial" => "1140"
                        "paginaFinal" => "1147"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20947649"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preventing complications of central venous catheterization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; McGee"
                            1 => "M&#46;K&#46; Gould"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra011883"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2003"
                        "volumen" => "348"
                        "paginaInicial" => "1123"
                        "paginaFinal" => "1133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12646670"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central vascular catheter placement evaluation using saline flush and bedside echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Weekes"
                            1 => "D&#46;A&#46; Johnson"
                            2 => "S&#46;M&#46; Keller"
                            3 => "B&#46; Efune"
                            4 => "C&#46; Carey"
                            5 => "N&#46;L&#46; Rozario"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/acem.12283"
                      "Revista" => array:7 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "paginaInicial" => "65"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24552526"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2213260014701535"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "British Thoracic Society&#46; Pleural disease guideline 2010&#46; A quick reference guide&#46;"
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Procedural applications of ultrasound"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;D&#46; Tibbles"
                            1 => "W&#46; Porcaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.emc.2004.04.010"
                      "Revista" => array:7 [
                        "tituloSerie" => "Emerg Med Clin North Am"
                        "fecha" => "2004"
                        "volumen" => "22"
                        "paginaInicial" => "797"
                        "paginaFinal" => "815"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15301851"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508514002194"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hand-carried cardiac ultrasound &#40;HCU&#41; device&#58; recommendations regarding new&#44; technology&#46; A report from the echocardiography task force on new technology of the Nomenclature and Standards Committee of the American Society of Echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;B&#46; Seward"
                            1 => "P&#46;S&#46; Douglas"
                            2 => "R&#46; Erbel"
                            3 => "R&#46;E&#46; Kerber"
                            4 => "I&#46; Kronzon"
                            5 => "H&#46; Rakowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "2002"
                        "volumen" => "15"
                        "paginaInicial" => "369"
                        "paginaFinal" => "373"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11944016"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Ultrasonido en emergencias y trauma &#40;USET&#41;"
                        "serieFecha" => "2007"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American College of Chest Physicians&#47;La Societ&#233; de R&#233;animation de Langue Fran&#231;aise statement on competence in critical care ultrasonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;H&#46; Mayo"
                            1 => "Y&#46; Beaulieu"
                            2 => "P&#46; Doelken"
                            3 => "D&#46; Feller-Kopman"
                            4 => "C&#46; Harrod"
                            5 => "A&#46; Kaplan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.08-2305"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2009"
                        "volumen" => "135"
                        "paginaInicial" => "1050"
                        "paginaFinal" => "1060"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19188546"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International expert statement on training standards for critical care ultrasonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Expert Round Table on Ultrasound in ICU"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-011-2246-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1077"
                        "paginaFinal" => "1083"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21614639"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid cardiac ultrasound of inpatients suffering PEA performed by nonexpert sonographers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Niendorff"
                            1 => "A&#46;J&#46; Rassias"
                            2 => "R&#46; Palac"
                            3 => "M&#46;L&#46; Beach"
                            4 => "S&#46; Costa"
                            5 => "M&#46; Greenberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.resuscitation.2005.04.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Resuscitation"
                        "fecha" => "2005"
                        "volumen" => "67"
                        "paginaInicial" => "81"
                        "paginaFinal" => "87"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16199290"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Feasibility and reliability of point of care pocket-size echocardiography performed by medical residents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "O&#46;C&#46; Mj&#248;lstad"
                            1 => "G&#46;N&#46; Andersen"
                            2 => "H&#46; Dalen"
                            3 => "T&#46; Graven"
                            4 => "K&#46; Skjetne"
                            5 => "J&#46;O&#46; Kleinau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ehjci/jet062"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J Cardiovasc Imaging"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "1195"
                        "paginaFinal" => "1202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23644936"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focused cardiac ultrasound in the emergent setting&#58; a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Labovitz"
                            1 => "V&#46;E&#46; Noble"
                            2 => "M&#46; Bierig"
                            3 => "S&#46;A&#46; Goldstein"
                            4 => "R&#46; Jones"
                            5 => "S&#46; Kort"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2010.10.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "2010"
                        "volumen" => "23"
                        "paginaInicial" => "1225"
                        "paginaFinal" => "1230"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21111923"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transthoracic echocardiography for cardiopulmonary monitoring in intensive care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;B&#46; Jensen"
                            1 => "E&#46; Sloth"
                            2 => "K&#46;M&#46; Larsen"
                            3 => "M&#46;D&#46; Schmidt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2004"
                        "volumen" => "21"
                        "paginaInicial" => "700"
                        "paginaFinal" => "707"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15595582"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Echocardiography in the ICU&#58; time for widespread use&#33;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;P&#46; Cholley"
                            1 => "A&#46; Vieillard-Baron"
                            2 => "A&#46; Mebazaa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-005-2833-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "9"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16292627"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Echocardiographic hemodynamic monitoring in the critically ill patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46;J&#46; Romero-Bermejo"
                            1 => "M&#46; Ruiz-Bailen"
                            2 => "M&#46; Guerrero-De-Mier"
                            3 => "J&#46; Lopez-Alvaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Cardiol Rev"
                        "fecha" => "2011"
                        "volumen" => "7"
                        "paginaInicial" => "146"
                        "paginaFinal" => "156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22758613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Barbier"
                            1 => "Y&#46; Loubi&#232;res"
                            2 => "C&#46; Schmit"
                            3 => "J&#46; Hayon"
                            4 => "J&#46;L&#46; Ric&#244;me"
                            5 => "F&#46; Jardin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-004-2259-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "1740"
                        "paginaFinal" => "1746"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15034650"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Vieillard"
                            1 => "K&#46; Chergui"
                            2 => "A&#46; Rabiller"
                            3 => "O&#46; Peyrouset"
                            4 => "B&#46; Page"
                            5 => "A&#46; Beauchet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-004-2361-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "1734"
                        "paginaFinal" => "1739"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15375649"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure&#58; need for a cautious use"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Muller"
                            1 => "X&#46; Bobbia"
                            2 => "M&#46; Toumi"
                            3 => "G&#46; Louart"
                            4 => "N&#46; Molinari"
                            5 => "B&#46; Ragonnet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc11672"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2012"
                        "volumen" => "16"
                        "paginaInicial" => "R188"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23043910"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the echocardiographic assessment of the right heart in adults&#58; a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography&#44; a registered branch of the European Society of Cardiology&#44; and the Canadian Society of Echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Rudski"
                            1 => "W&#46;W&#46; Lai"
                            2 => "J&#46; Afilalo"
                            3 => "L&#46; Hua"
                            4 => "M&#46;D&#46; Handschumacher"
                            5 => "K&#46; Chandrasekaran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2010.05.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "2010"
                        "volumen" => "23"
                        "paginaInicial" => "685"
                        "paginaFinal" => "713"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20620859"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory variations of aortic VTI&#58; a new index of hypovolemia and fluid responsiveness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Slama"
                            1 => "H&#46; Masson"
                            2 => "J&#46;L&#46; Teboul"
                            3 => "M&#46;L&#46; Arnout"
                            4 => "D&#46; Susic"
                            5 => "E&#46; Frohkich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Physiol Heart Circ Physiol"
                        "fecha" => "2002"
                        "volumen" => "283"
                        "paginaInicial" => "1729"
                        "paginaFinal" => "1733"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pericardial effusion&#58; haemodynamic spectrum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Shabetai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2004"
                        "volumen" => "90"
                        "paginaInicial" => "255"
                        "paginaFinal" => "256"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14966038"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Triage patients with suspected pulmonary embolism in the emergency department using a portable ultrasound device"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Mansencal"
                            1 => "A&#46; Vileillard-Baron"
                            2 => "A&#46; Beauchet"
                            3 => "J&#46;C&#46; Farcot"
                            4 => "M&#46; El Hajjam"
                            5 => "G&#46; Dufaitre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1540-8175.2007.00623.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Echocardiography"
                        "fecha" => "2008"
                        "volumen" => "25"
                        "paginaInicial" => "451"
                        "paginaFinal" => "456"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18452470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International Liaison Committee on Lung Ultrasound &#40;ILC-LUS&#41; for International Consensus Conference on Lung Ultrasound&#40;ICC-LUS&#41;&#46; International evidence-based recommendations for point-of-care lung ultrasound"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Volpicelli"
                            1 => "M&#46; Elbarbary"
                            2 => "M&#46; Blaivas"
                            3 => "D&#46;A&#46; Lichtenstein"
                            4 => "G&#46; Mathis"
                            5 => "A&#46;W&#46; Kirkpatrick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2513-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "577"
                        "paginaFinal" => "591"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22392031"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung ultrasound in the critically ill"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Lichtenstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCC.0000000000000096"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2014"
                        "volumen" => "20"
                        "paginaInicial" => "315"
                        "paginaFinal" => "322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24758984"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000371/v1_201510250024/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "34050"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Review articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004300000004/v1_201510250024/S2256208715000371/v1_201510250024/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000371?idApp=UINPBA00004N"
]

Article information

ISSN: 22562087
Original language: English

DOI:10.1016/j.rcae.2015.05.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	1	9
2024 October	38	5	43
2024 September	50	3	53
2024 August	34	7	41
2024 July	48	11	59
2024 June	70	7	77
2024 May	67	6	73
2024 April	82	6	88
2024 March	173	7	180
2024 February	143	12	155
2024 January	166	12	178
2023 December	68	19	87
2023 November	87	11	98
2023 October	64	10	74
2023 September	54	17	71
2023 August	27	13	40
2023 July	35	3	38
2023 June	50	5	55
2023 May	91	3	94
2023 April	80	7	87
2023 March	69	7	76
2023 February	43	6	49
2023 January	73	6	79
2022 December	52	9	61
2022 November	58	12	70
2022 October	30	10	40
2022 September	50	7	57
2022 August	55	19	74
2022 July	25	7	32
2022 June	31	11	42
2022 May	64	12	76
2022 April	31	9	40
2022 March	77	14	91
2022 February	45	8	53
2022 January	83	7	90
2021 December	47	10	57
2021 November	33	6	39
2021 October	44	4	48
2021 September	20	6	26
2021 August	32	10	42
2021 July	26	7	33
2021 June	22	8	30
2021 May	37	5	42
2021 April	90	8	98
2021 March	86	10	96
2021 February	35	5	40
2021 January	36	12	48
2020 December	46	4	50
2020 November	42	7	49
2020 October	23	7	30
2020 September	36	4	40
2020 August	61	12	73
2020 July	20	14	34
2020 June	24	2	26
2020 May	33	9	42
2020 April	32	2	34
2020 March	21	4	25
2020 February	25	2	27
2020 January	23	4	27
2019 December	41	9	50
2019 November	14	3	17
2019 October	23	4	27
2019 September	12	2	14
2019 August	2	0	2
2019 July	3	11	14
2019 June	4	5	9
2019 May	0	9	9
2019 April	1	0	1
2018 September	1	0	1
2018 June	13	3	16
2018 May	64	6	70
2018 April	67	4	71
2018 March	50	7	57
2018 February	51	5	56
2018 January	49	5	54
2017 December	39	3	42
2017 November	46	5	51
2017 October	45	8	53
2017 September	48	12	60
2017 August	33	4	37
2017 July	56	3	59
2017 June	87	5	92
2017 May	101	10	111
2017 April	71	13	84
2017 March	87	9	96
2017 February	126	4	130
2017 January	41	8	49
2016 December	62	14	76
2016 November	110	18	128
2016 October	136	16	152
2016 September	187	7	194
2016 August	162	15	177
2016 July	64	4	68
2016 June	3	5	8
2016 May	3	27	30
2016 April	1	32	33
2016 March	2	0	2
2016 February	8	40	48
2015 December	25	13	38
2015 November	66	35	101
2015 October	3	1	4

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter