EASy MAP
Hypotension
EASy ALS
Cardiac Arrest
EASy Sepsis
Septic Shock
EASy PDA
Difficult Airway
EASy FAST
Trauma
Core Protocol

EASy MAP Protocol

A systematic approach to evaluating the hypotensive patient using point-of-care ultrasound

Overview

What is EASy MAP?

EASy MAP stands for Echocardiographic Assessment using Subxiphoid-Only -- Mean Arterial Pressure.

It is a concise point-of-care ultrasound examination designed for immediate determination of cardiovascular and cardiorespiratory status in patients with hypotension (MAP < 65 mmHg).

Key Features

  • Rapid acquisition -- Complete exam in under 5 minutes
  • Single probe -- Uses only a phased array transducer
  • Pattern recognition -- Identify hemodynamic phenotypes quickly
  • Beginner-friendly -- 87% success rate after 1-day training

Patient Inclusion Criteria

Inclusion:

Mean Arterial Pressure (MAP) < 65 mmHg

Exclusions:

  • Cardiac arrest with active compressions
  • Unable to tolerate supine position
  • Extreme obesity limiting image quality
Image Acquisition

The 6 EASy Views

Systematically acquire these six views using a phased array probe

1

Subcostal 4-Chamber View

Probe Position

  • Place probe 2 cm inferior to xiphoid process
  • Marker facing toward patient's left (3 o'clock)
  • Use overhand grip
  • Trap small skin fold for good contact
  • Angle probe tail caudally toward patient's right

What to Assess

  • Both ventricles (LV and RV)
  • Both atria (LA and RA)
  • Tricuspid and mitral valves
  • Global LV and RV function
  • Pericardium for effusion
Subcostal 4-Chamber View

Visualizes all 4 cardiac chambers

2

Subcostal IVC View

Probe Position

  • Remove probe entirely from subcostal area
  • Rotate marker to point cephalad (12 o'clock)
  • Reposition at same location
  • Angle beam slightly toward patient's left to identify aorta

What to Assess

  • IVC Diameter: Normal 0.9-2.1 cm
  • Collapsibility: >50% = collapsible
  • Positively identify both IVC and aorta
  • Look for hepatic vein draining into IVC

Critical: Always identify the aorta to avoid mistaking it for a non-collapsing IVC.

Subcostal IVC View

Assess preload and volume status

3-4

Upper Lung Views (Right & Left)

Probe Position

  • 2nd intercostal space at midclavicular line
  • Marker pointing cephalad (12 o'clock)
  • Slide or tilt to minimize rib shadowing
  • Repeat on both sides

What to Assess

  • A-lines: Horizontal artifacts (normal/dry)
  • B-lines: Vertical artifacts (wet/edema)
  • Lung sliding: Normal pleural movement
Upper Lung Views

A-lines vs B-lines assessment

5-6

Pleural Views (Right & Left)

Probe Position

  • Right: Midaxillary line, same plane as subcostal view
  • Left: Posterior axillary line, same horizontal plane
  • Marker at 12 o'clock
  • Identify liver/spleen, diaphragm, spine, and lung

What to Assess

  • Pleural effusion or hemothorax
  • Consolidation - spine sign, loss of curtain
  • Diaphragm movement
Pleural Views

Effusion and consolidation

Interpretation

Hemodynamic Phenotypes

Pattern recognition for rapid diagnosis and management

Cluster 1Small/Normal Cavity with Normal or Increased Contractility
1Hypovolemic Shock

Findings

  • Small LV and RV cavities
  • hyperdynamic function
  • flat collapsing IVC
  • A-lines on lung ultrasound

Consider: Hemorrhage, dehydration, third-spacing

2Distributive Shock

Findings

  • Normal/adequate LV and RV cavities
  • hyperdynamic function
  • normal or dilated IVC
  • A-lines on lung ultrasound

Consider: Sepsis, anaphylaxis, neurogenic shock

3Diastolic Dysfunction

Findings

  • Thick-walled LV (concentric hypertrophy)
  • small cavity appearance
  • may be hypovolemic or distributive

Consider: Chronic hypertension, HFpEF

Cluster 2Enlarged LV +/- RV with Decreased Contractility
4Cardiogenic Shock (LV)

Findings

  • Dilated LV
  • severely reduced LV function
  • plethoric IVC
  • B-lines on lung ultrasound

Consider: AMI, cardiomyopathy, myocarditis

5Biventricular Failure

Findings

  • Both LV and RV dilated
  • globally reduced function
  • plethoric IVC
  • bilateral B-lines

Consider: End-stage cardiomyopathy, pulmonary edema

Cluster 3Isolated Enlarged RV
6Acute RV Failure

Findings

  • RV > LV (RV/LV > 1)
  • septal shift toward LV
  • thin RV wall
  • plethoric IVC

Consider: Massive PE, acute ARDS

7Acute on Chronic RV Failure

Findings

  • RV dilation with thick wall (>1 cm)
  • RA enlargement
  • septal flattening
  • plethoric IVC

Consider: Pulmonary HTN, chronic PE, COPD

Cluster 4Obstructive Causes
8Pericardial Tamponade

Findings

  • Pericardial effusion >10mm
  • chamber collapse (RA/RV diastolic)
  • plethoric IVC
9Catastrophic Valve Disease

Findings

  • Visible valve abnormality
  • chamber dilation
  • plethoric IVC
  • B-lines pattern
10Tension Pneumothorax / Auto-PEEP

Findings

  • Small hyperdynamic heart
  • plethoric IVC
  • no lung sliding
  • barcode sign on M-mode
Downloads

Protocol Resources

Downloadable guides, checklists, and reference cards

EASy MAP Reference Card

Pocket-sized quick reference for the 6 views and interpretation

Phenotype Guide

Visual guide to all 10 hemodynamic phenotypes with differential diagnoses

Image Acquisition Checklist

Step-by-step checklist for systematic image acquisition

Quality Scoring System

12-point scoring system for cardiac image quality assessment

Ready to learn EASy MAP?

Enroll in the fundamentals course or download the reference materials.