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

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 PTX by scanning longitudinally in anterior 3rd IC space
    • Look for lack of sliding or use M-mode to look for reassuring beach sign

Source

Weingart - http://emcrit.org/ultrasound/The%20RUSH%20Examfinal.htm