Abdominal and Cardiothoracic Evaluation with Sonography in Shock (ACES)

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Authors: Paul Atkinson, James A Connolly, Robert D Jarman, John P Sloan, John Wright / Editors: Nishant Cherian, Emma Everitt / Codes: Published: 28/02/2024

This learning session covers ACES scans which can provide crucial information in undifferentiated shocked patients.

Learning objectives

After completing this session, you will be able to:

  • Explain the indications for an ACES scan
  • Know which probes to use and how to adjust the machine
  • Describe how to position the patient
  • Demonstrate the key views
  • Appreciate the clinical application of the findings
  • Evaluate when repeat, or alternative imaging is required


  1. Reardon R, Heegaard B, et al. Ultrasound is a necessary skill for emergency physicians. Acad Emerg Med. 2006 Mar;13(3):334-6.
  2. Jones AE, Yiannibas V, Johnson C, Kline JA. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. Chest. 2006 Oct;130(4):941-6.
  3. Jones AE, Tayal VS, Sullivan DM, Kline JA. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004 Aug;32(8):1703-8.
  4. Rose JS, Bair AE, Mandavia D, Kinser DJ. The UHP ultrasound protocol: a novel ultrasound approach to the empiric evaluation of the undifferentiated hypotensive patient. Am J Emerg Med. 2001 Jul;19(4):299-302.
  5. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005 Jan;23(1):45-50.
  6. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6.
  7. Brennan JM, Blair JE, Goonewardena S, et al.Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr. 2007 Jul;20(7):857-61.
  8. Nabavizadeh SA, Meshksar A. Ultrasonographic diagnosis of cardiac tamponade in trauma patients using collapsibility index of inferior vena cava. Acad Radiol. 2007 Apr;14(4):505-6.
  9. Gudmundsson P, Rydberg E, Winter R, Willenheimer R. Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol. 2005 May 25;101(2):209-12.
  10. Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med. 2002 Mar;9(3):186-93.
  11. Randazzo MR, Snoey ER, Levitt MA, Binder K. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med. 2003 Sep;10(9):973-7.
  12. Jones AE, Craddock PA, Tayal VS, Kline JA. Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Shock. 2005 Dec;24(6):513-7.
  13. The Royal College of Emergency Medicine (RCEM). Point of Care Emergency Ultrasound Course. Cambridge, 2024.
  14. Mandavia DP, Hoffner RJ, Mahaney K, Henderson SO. Bedside echocardiography by emergency physicians. Ann Emerg Med. 2001 Oct;38(4):377-82.
  15. Dent B, Kendall RJ, Boyle AA, Atkinson PR. Emergency ultrasound of the abdominal aorta by UK emergency physicians: a prospective cohort study. Emerg Med J. 2007 Aug;24(8):547-9.
  16. Carr BG, Dean AJ, Everett WW, et al. Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study. J Trauma. 2007 Sep;63(3):495-500; discussion 500-2.

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