Ultrasound: In Shock and Hypotension

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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

  • 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

  • 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"

See Also

Source