Schematic drawing of transducer, the image planes and key points in the SEARCH 8Es protocol.
The performance sequence of SEARCH 8Es was divided into two steps. (A) The first step of ‘SEARCH’ with the convex probe to search for the pneumothorax, interstitial syndrome (pulmonary edema, ARDS, interstitial disease), pneumonia, pleural effusion, peritoneal effusion, abdominal aortic aneurysm, aortic dissection, or a clue of hypovolemia. The convex probe is located longitudinally on the anterior chest and posterolateral chest to examine whether there are any findings that are suggestive of empty thorax, edematous or wet lung and free fluid above and below the diaphragm. In cases of intraperitoneal fluid, the probe is placed in the same manner as the conventional FAST. The convex probe is used to evaluate the lungs, the abdomen and to look at the IVC. The A profile is defined the conditions appeared lung sliding with A line in both lungs. The A’ profile is an A profile without lung sliding and lung point. The B profile is defined to anterior-predominant bilateral B lines associated with lung sliding. The B’ profile is a B profile without lung sliding. The A/B profile is defined to anterior predominant B lines on one lung and predominant A lines on the other. The C profile is defined to anterior alveolar consolidation(s). (B) The 2nd step of ‘SEARCH’ with the cardiac probe to search for pericardial effusion with or without tamponade physiology (diastolic right ventricle collapse), pulmonary embolism (right ventricle enlargement, paradoxical interventricular septal movement), left ventricle systolic dysfunction, acute myocardial infarction (left and right ventricular regional wall motion abnormality) and it’s mechanical complications (papillary muscular rupture, left ventricle wall rupture), and a clue of a hypovolemic or distributive shock (hypokinetic small-sized left ventricle or hyperkinetic normal-sized left ventricle). In case of chest pain, parasternal short axis view and suprasternal notch view was performed due to the evaluation of regional wall motion and thoracic aorta dissection or aneurysm. If the apical 4 chamber view is difficult due to poor window, a subxiphoid view is used. AAA, abdominal aortic aneurysm; AD, aortic dissection; ARDS, acute respiratory distress syndrome; BLUE, bedside lung ultrasound in emergency; EF, ejection fraction; E-FAST, extended focused assessment with sonography for trauma; FAST, focused assessment with sonography for trauma; IVC, inferior vena cava; LA, left atrium; LUQ, left upper quadrant; LV, left ventricle; PLAPS, posterolateral alveolar and/or pleural syndrome; RA, right atrium; RUQ, right upper quadrant; RV, right ventricle; SEARCH, sonographic evaluation of aetiology for respiratory difficulty, chest pain, and/or hypotension.
