SIMPLE Mnemonic
The following mnemonic can be used in patients with persistent hypotension of unknown cause. There are numerous mnemonics & protocols used in POCUS, this is just an example. You can use your own if you prefer.
| SIMPLE approach in FCU | |
|---|---|
| S | Chamber Size and Shape, particularly LV and RV size |
| I | IVC size and collapsibility IVS movement Intimal flaps inside the aorta, suggestive of aortic dissection |
| M | Mass in the heart chambers (commonly intramural clots and atrial myxoma) Myocardium (motion and thickness) |
| P | Pericardial effusion |
| L | Left ventricular systolic function |
| E | Abdominal aorta in the Epigastrium |
SIMPLE mnemonic for FCU in shock. Ref: Mok Ka Leung. Journal of Intensive Care 2016
SIMPLE – POET
We can add on scanning of the lungs to complete our evaluation of the hypotensive patient. Use the POET mnemonic.
P = Pneumonia
O = Pulmonary Oedema
E = Effusion
T = Tension Pneumothorax
Clinical Case Scenario
Let’s look at a patient who is short of breath and hypotensive. He is post op day 1 following a liver resection and distal pancreatectomy.
What does the focused cardiac ultrasound show ?
This is an apical 4 chamber view. The left ventricle is located on the right of the screen.
We can see that the apex and mid cavity of the left ventricle hardly contracts. There is limited endocardial excursion and wall thickening. Only the basal portions of the LV are contracting.
What about the lung ultrasound show ?
The lung ultrasound shows B-lines bilaterally. These are echogenic laser like projections extending from the pleural line into the parenchyma. They are indicative of oedema. We will cover this in more detail in the lung ultrasound module.
Diagnosis ?
The history and ultrasound findings are consistent with Takotsubo’s Cardiomyopathy. The differential diagnosis includes acute myocardial infarction.
Further Reading: Takotsubo’s Cardiomyopathy. Akashi et al. Circulation 2008.