Difference between revisions of "Ultrasound: In Shock and Hypotension"

(Pulmonary)
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==Pulmonary==
 
==Pulmonary==
*Assess for subpleural interstitial edema by scanning with the abdominal probe in the upper lateral chest bilaterally.
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*Assess for subpleural interstitial edema
**Look for multiple comet tail artifacts (a few, 3-4, are OK)If multiple are found, there is interstitial edema.
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**Scan with the abdominal probe in the upper lateral chest bilaterally
**If you see any comet tail artifact, there is no PTX.
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**Look for multiple comet tail artifacts (a few, 3-4, are OK)
*Assess for PTX separately by scanning longitudinally in anterior 3rd IC space, mid-clavicular line.
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***If multiple found, there is interstitial edema
 +
*Assess for pneumothorax
 +
**Scan longitudinally in anterior 3rd IC space, mid-clavicular line
 
**Look for lack of sliding or use M-mode to look for reassuring beach sign
 
**Look for lack of sliding or use M-mode to look for reassuring beach sign
  
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==Source==
 
==Source==
Weingart - http://emcrit.org/ultrasound/The%20RUSH%20Examfinal.htm
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*Weingart - http://emcrit.org/ultrasound/The%20RUSH%20Examfinal.htm
  
 
[[Category:Airway/Resus]]
 
[[Category:Airway/Resus]]
 
[[Category:Cards]]
 
[[Category:Cards]]
 
[[Category:Rads]]
 
[[Category:Rads]]

Revision as of 06:12, 6 May 2012

Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach

Heart

  • 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

IVC

  • Measurae 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; pt requires inotropes

Morison's

  • Look for fluid at lung/diaphragm interface

Aorta

  • If >5cm assume ruptured AAA until proven otherwise

Pulmonary

  • Assess for subpleural interstitial edema
    • Scan with the abdominal probe in the upper lateral chest bilaterally
    • Look for multiple comet tail artifacts (a few, 3-4, are OK)
      • If multiple found, there is interstitial edema
  • Assess for pneumothorax
    • Scan longitudinally in anterior 3rd IC space, mid-clavicular line
    • Look for lack of sliding or use M-mode to look for reassuring beach sign

See Also

Source