Jones

"The JONES PROTOCOL"

The goal directed ultrasound protocol consists of seven views of the torso, performed in a systematic and standardized order:

1. Subcostal view: The subcostal region of the abdomen was examined for anechoic collections within the pericardium suggesting tamponade, judged to be present by visual inspection for right ventricular diastolic collapse. 

2. Inferior vena cava (IVC) view: The IVC was examined for diameter and visual estimation of collapsibility to estimate intravascular volume status. A 50% collapse of IVC with inspiration was considered abnormal suggesting low intravascular volume, and 50% collapse of IVC with inspiration was considered normal suggesting normal intravascular volume . 

3. Parasternal long cardiac view: The left parasternal chest was examined for visual estimation of qualitative left ventricular function and pericardial effusion. Left ventricular function was judged by visual inspection of gross wall contraction and wall thickening during systole and diastole .

 4. Apical four-chamber cardiac view: The apex of the heart was examined in the transverse plane for visual estimation of relative ventricular size and qualitative function . 

5. Hepatorenal recess view: The space between the liver and right kidney was examined for anechoic collections in a sweeping motion using both in the coronal and transverse planes to survey for free intraperitoneal fluid . 

6. The pelvis and retrovesical area were examined in both the sagittal and transverse planes for the presence of anechoic fluid collections . 

7. Abdominal aorta view: The abdomen was examined in the transverse and sagittal planes for evidence of aneurysm of the proximal and distal aorta (any diameter 3 cm)

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.