Difference between revisions of "Ultrasound: In Shock and Hypotension"
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− | Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach | + | ==Background== |
+ | *Several techniques are available for differentiating shock states | ||
+ | *RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology<ref>Weingart - https://emcrit.org/rush-exam/</ref> | ||
+ | #The Pump | ||
+ | #*RV:LV | ||
+ | #*Squeeze | ||
+ | #*[[Pericardial effusion]] | ||
+ | #The Tank | ||
+ | #*IVC | ||
+ | #*[[Pleural effusions]] | ||
+ | #*[[Pulmonary edema]] | ||
+ | #The Pipes | ||
+ | #*[[AAA]] | ||
+ | #*[[Aortic dissection]] | ||
+ | #*[[DVT]] | ||
+ | |||
+ | ==The Protocol== | ||
+ | [[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) | ||
+ | *'''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== | ==Heart== | ||
+ | Technique: see [[Cardiac ultrasound]] | ||
*Pericardial Effusion | *Pericardial Effusion | ||
**Parasternal long | **Parasternal long | ||
Line 12: | Line 40: | ||
==IVC== | ==IVC== | ||
+ | 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 [[FAST exam]] |
+ | *Assess for free fluid | ||
+ | **Morison's pouch | ||
+ | **Splenorenal | ||
+ | **Bladder | ||
==Aorta== | ==Aorta== | ||
+ | Technique: see [[Aortic ultrasound]] | ||
*If >5cm assume ruptured AAA until proven otherwise | *If >5cm assume ruptured AAA until proven otherwise | ||
==Pulmonary== | ==Pulmonary== | ||
+ | Technique: see [[Ultrasound: Lungs]] | ||
*Assess for subpleural interstitial edema | *Assess for subpleural interstitial edema | ||
− | |||
**Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK) | **Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK) | ||
***If multiple found, there is interstitial edema | ***If multiple found, there is interstitial edema | ||
*Assess for pneumothorax | *Assess for pneumothorax | ||
**Scan longitudinally in anterior 2nd-3rd IC space, mid-clavicular line | **Scan longitudinally in anterior 2nd-3rd IC space, mid-clavicular line | ||
− | **Look for lack of sliding or | + | **Look for lack of sliding or "beach sign" |
+ | |||
+ | ==Other== | ||
+ | {{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/> | |
− | [[Category: | + | [[Category:Critical Care]] |
− | [[Category: | + | [[Category:Cardiology]] |
− | [[Category: | + | [[Category:Radiology]] |
+ | [[Category:Ultrasound]] |
Latest revision as of 14:14, 12 December 2020
Contents
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
See Also
References
- ↑ Weingart - https://emcrit.org/rush-exam/
- ↑ 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