Clinical Research Directory

Inclusion Criteria: 1- Adult patients aged ≥18 years. 2.Both male and female patients will be included in the study. 3. Presentation to the Emergency Department with clinical evidence of shock, defined by: Hypotension (systolic blood pressure \<90 mmHg or mean arterial pressure \<65 mmHg). Evidence of tissue hypoperfusion (e.g., altered mental status, cold extremities, or oliguria). Elevated serum lactate (\>2 mmol/L). 4. Shock attributed to hypovolemic, septic, or hemorrhagic etiologies. 5. Patients requiring fluid resuscitation and hemodynamic monitoring. Exclusion Criteria: 1 - Patients younger than 18 years. 2. Pregnancy. 3.Cardiogenic or obstructive shock (e.g., cardiac tamponade, massive pulmonary embolism, or tension pneumothorax). 4.Known inferior vena cava (IVC) anomalies (e.g., congenital absence, thrombosis). 5\. Increased intra-abdominal pressure or severe ascites. 6. Morbid obesity (BMI ≥40 kg/m²) or any condition interfering with adequate IVC ultrasound visualization. 7\. Prior central venous catheterization performed before Emergency Department arrival. 8\. Congestive heart failure (CHF) with left ventricular ejection fraction (LVEF \<40%) or pulmonary hypertension. 9\. Refusal of the patient or legal guardian to participate in the study.