Ultrasound: In Shock and Hypotension
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
- Walls move >90% or touch at end of systole
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