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

Abstract

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

Screening for Subclavian Artery Stenosis

“…The "best" (i.e., lowest) HAT value was used in the analysis. We have previously speculated that a "normal" HAT is ≤100 ms. 1,2 The presence of asymptomatic and symptomatic subclavian artery stenosis was correlated with the IBP (≥15 and ≥20 mm Hg), AAI (<0.9 and <0.8), and HAT (≤100 or >100 ms).…”

“…Our group has been studying the potential utility of hand acceleration time (HAT) in determining the clinical perfusion state of the extremity. 1,2 We wished to study the utility of IBP, AAI, and HAT in identifying significant and symptomatic subclavian artery stenosis.…”