Ultrasound: In Shock and Hypotension: Difference between revisions
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==Background== | ==Background== | ||
*Several techniques are available for differentiating shock states | *Several techniques are available for differentiating shock states | ||
*RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology | *RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology<ref>Weingart - http://emcrit.org/ultrasound/The%20RUSH%20Examfinal.htm</ref> | ||
#The Pump | #The Pump | ||
# | #*RV:LV | ||
# | #*Squeeze | ||
# | #*[[Pericardial effusion]] | ||
#The Tank | #The Tank | ||
# | #*IVC | ||
# | #*[[Pleural effusions]] | ||
# | #*[[Pulmonary edema]] | ||
#The Pipes | #The Pipes | ||
# | #*[[AAA]] | ||
# | #*[[Aortic dissection]] | ||
# | #*[[DVT]] | ||
==The Protocol== | ==The Protocol== | ||
Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach<ref>Dina Seif. Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol Critical Care Research and Practice Vol 2012 http://downloads.hindawi.com/journals/ccrp/2012/503254.pdf </ref> | [[File:Cardiac Ultrasound.png|thumb|Step 1: The Pump]] | ||
[[File:Step 2.png|thumb|Step 2: The Tank]] | |||
[[File:Step 3.png|thumb|Step 3: The Pipes]] | |||
Rapid Ultrasound for Shock and [[Hypotension]](RUSH) using the HI-MAP approach<ref>Dina Seif. Bedside Ultrasound in Resuscitation and the Rapid Ultrasound | |||
in Shock Protocol Critical Care Research and Practice Vol 2012 http://downloads.hindawi.com/journals/ccrp/2012/503254.pdf </ref> | |||
*'''H''' - Heart (parasternal and four-chamber views) | *'''H''' - Heart (parasternal and four-chamber views) | ||
*'''I''' - Inferior Vena Cava (for volume responsiveness) | *'''I''' - Inferior Vena Cava (for volume responsiveness) | ||
*'''M''' - | *'''M''' - Morison’s pouch (i.e., FAST exam) and views of thorax (looking for free fluid) | ||
*'''A''' - Aortic Aneurysm (ruptured abdominal aneurysm) | *'''A''' - Aortic Aneurysm (ruptured abdominal aneurysm) | ||
*'''P''' - Pneumothorax (i.e., Tension | *'''P''' - Pneumothorax (i.e., Tension pneumothorax) | ||
==Heart== | ==Heart== | ||
Technique: see [[ | Technique: see [[Cardiac ultrasound]] | ||
*Pericardial Effusion | *Pericardial Effusion | ||
**Parasternal long | **Parasternal long | ||
Line 36: | Line 40: | ||
==IVC== | ==IVC== | ||
Technique: see [[ | Technique: see [[IVC ultrasound]] | ||
*Measure 2cm from RA-IVC junction | *Measure 2cm from RA-IVC junction | ||
*If IVC <1.5cm and collapses on inspiration then CVP is low | *If IVC <1.5cm and collapses on inspiration then CVP is low | ||
*If IVC >2.5cm and noncollapsing then CVP is high | *If IVC >2.5cm and noncollapsing then CVP is high | ||
**Suggests fluid unresponsive; | **Suggests fluid unresponsive; patient requires inotropes | ||
==Morison's== | ==Morison's== | ||
Technique: see [[ | Technique: see [[FAST exam]] | ||
*Assess for free fluid | *Assess for free fluid | ||
**Morison's pouch | **Morison's pouch | ||
Line 50: | Line 54: | ||
==Aorta== | ==Aorta== | ||
Technique: see [[ | Technique: see [[Aortic ultrasound]] | ||
*If >5cm assume ruptured AAA until proven otherwise | *If >5cm assume ruptured AAA until proven otherwise | ||
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==Other== | ==Other== | ||
{{Ultrasound findings for critically ill patients table}} | {{Ultrasound findings for critically ill patients table}} | ||
==Video== | |||
{{#widget:YouTube|id= tqBdKIdKqOc}} | |||
{{#widget:YouTube|id= IjmF-132sHA}} | |||
{{#widget:YouTube|id= oXiIU4mx-H8}} | |||
{{#widget:YouTube|id= 9UyVHqvGgHE}} | |||
==See Also== | ==See Also== | ||
*[[Ultrasound ( | *[[Ultrasound (main)]] | ||
*[[ | *[[Undifferentiated shock]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Critical Care]] | ||
[[Category: | [[Category:Cardiology]] | ||
[[Category: | [[Category:Radiology]] | ||
[[Category:Ultrasound]] |
Revision as of 17:52, 27 June 2017
Background
- Several techniques are available for differentiating shock states
- RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology[1]
- The Pump
- RV:LV
- Squeeze
- Pericardial effusion
- The Tank
- The Pipes
The Protocol
Rapid Ultrasound for Shock and Hypotension(RUSH) using the HI-MAP approach[2]
- H - Heart (parasternal and four-chamber views)
- I - Inferior Vena Cava (for volume responsiveness)
- M - Morison’s pouch (i.e., FAST exam) and views of thorax (looking for free fluid)
- A - Aortic Aneurysm (ruptured abdominal aneurysm)
- P - Pneumothorax (i.e., Tension pneumothorax)
Heart
Technique: see Cardiac ultrasound
- Pericardial Effusion
- Parasternal long
- Change in size <30% between sys and dia = poor LV function
- RV collapse
- In 4-chamber view, RV should be <60% of LV; if larger think RV failure
- Hyperdynamicity
- Walls move >90% or touch at end of systole
- May indicate hypovolemia or sepsis
- Walls move >90% or touch at end of systole
IVC
Technique: see IVC ultrasound
- Measure 2cm from RA-IVC junction
- If IVC <1.5cm and collapses on inspiration then CVP is low
- If IVC >2.5cm and noncollapsing then CVP is high
- Suggests fluid unresponsive; patient requires inotropes
Morison's
Technique: see FAST exam
- Assess for free fluid
- Morison's pouch
- Splenorenal
- Bladder
Aorta
Technique: see Aortic ultrasound
- If >5cm assume ruptured AAA until proven otherwise
Pulmonary
Technique: see Ultrasound: Lungs
- Assess for subpleural interstitial edema
- Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK)
- If multiple found, there is interstitial edema
- Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK)
- Assess for pneumothorax
- Scan longitudinally in anterior 2nd-3rd IC space, mid-clavicular line
- Look for lack of sliding or "beach sign"
Other
Classic Ultrasound Findings For Critically Ill Patients
Disease | IVC | Cardiac | Lung (Phased Array) | Lung (Linear) |
---|---|---|---|---|
MI | ↑ | Focal WMA Mod/Poor squeeze |
NL or B-lines | Sliding |
Tamponade | ↑ | RA collapse with filling RV collapse with filling |
NL | Sliding |
PTX | ↑ | NL or Hyperdynamic | Lung point Consolidated lung |
Absent lung sliding |
Sepsis | ↓ | Hyperdynamic squeeze | NL (see pneumonia) | Sliding |
Pneumonia | NL or ↓ | Hyperdynamic squeeze | Unilateral B-lines | Sliding |
Decompensated HF | ↑ | Mod/Poor squeeze | Bilateral B-lines | Sliding |
PE | ↑ | RV > LV McConnell's sign |
NL or Unilateral B-lines | Sliding |
Video
{{#widget:YouTube|id= tqBdKIdKqOc}}
{{#widget:YouTube|id= IjmF-132sHA}}
{{#widget:YouTube|id= oXiIU4mx-H8}}
{{#widget:YouTube|id= 9UyVHqvGgHE}}
See Also
References
- ↑ Weingart - http://emcrit.org/ultrasound/The%20RUSH%20Examfinal.htm
- ↑ Dina Seif. Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol Critical Care Research and Practice Vol 2012 http://downloads.hindawi.com/journals/ccrp/2012/503254.pdf