Ultrasound: In Shock and Hypotension
Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach
Heart
Technique: see Ultrasound: Cardiac
- 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
- 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; pt requires inotropes
Morison's
- Look for fluid at lung/diaphragm interface
Aorta
- Technique: see Ultrasound: Aorta
- If >5cm assume ruptured AAA until proven otherwise
Pulmonary
- Assess for subpleural interstitial edema
- see Ultrasound: Lungs
- Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK)
- If multiple found, there is interstitial edema
- Assess for pneumothorax
- Scan longitudinally in anterior 2nd-3rd IC space, mid-clavicular line
- Look for lack of sliding or "beach sign"