From the Research
The HI-MAP approach is a systematic ultrasound technique used to evaluate patients with hypotension or shock, focusing on key areas such as the Heart, Inferior vena cava, Morrison's pouch, Aorta, and Pneumothorax to quickly determine the cause of shock. This approach is valuable in emergency settings where time-sensitive decisions are needed, as it provides rapid, bedside information about the potential causes of shock, allowing clinicians to quickly determine whether the patient's condition stems from cardiogenic, hypovolemic, obstructive, or distributive causes 1.
Key Components of HI-MAP Approach
- Cardiac evaluation to assess contractility, chamber size, and effusion
- Examination of the inferior vena cava to determine volume status by measuring diameter and collapsibility
- Assessment of Morrison's pouch (the hepatorenal space) for free fluid indicating hemorrhage
- Evaluation of the aorta for aneurysms or dissection that might cause shock
- Examination of the lungs for pneumothorax, which could contribute to hemodynamic instability
The use of ultrasound in medical imaging and therapy has expanded beyond traditional radiology departments and cardiology practices, with advancements in computing power and data processing capabilities making ultrasound systems more portable and inexpensive 2. Ultrasound-targeted drug delivery is also an emerging field, offering a powerful approach to increase delivery, therapeutic efficacy, and temporal release of drugs 3, 4, 5. However, the HI-MAP approach specifically focuses on the evaluation of patients with hypotension or shock, rather than drug delivery or other therapeutic applications.
Benefits of HI-MAP Approach
- Provides rapid, bedside information about the potential causes of shock
- Allows clinicians to quickly determine the cause of shock and make time-sensitive decisions about fluid resuscitation, vasopressors, or other interventions
- Can be completed in minutes, making it particularly useful in emergency settings
- Enables clinicians to differentiate between cardiogenic, hypovolemic, obstructive, or distributive causes of shock, guiding appropriate treatment.