Ultrasound: In Shock and Hypotension

Revision as of 04:03, 1 January 2014 by Ostermayer (talk | contribs)

Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach[1]

H - Heart (parasternal and four-chamber views) I - Inferior Vena Cava (for volume responsiveness) M - Morrison’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 PTX)


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


Technique: see Ultrasound: 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


  • Look for fluid at lung/diaphragm interface


Technique: see Ultrasound: Aorta

  • If >5cm assume ruptured AAA until proven otherwise


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
  • Assess for pneumothorax
    • Scan longitudinally in anterior 2nd-3rd IC space, mid-clavicular line
    • Look for lack of sliding or "beach sign"

See Also


  1. 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