Ultrasound: In Shock and Hypotension

Revision as of 18:45, 21 April 2012 by Jgrimsman (talk | contribs) (Pulmonary)

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


  • 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


  • 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


  • Look for fluid at lung/diaphragm interface


  • If >5cm assume ruptured AAA until proven otherwise


  • Assess for subpleural interstitial edema by scanning with the abdominal probe in the upper lateral chest bilaterally.
    • Look for multiple comet tail artifacts (a few, 3-4, are OK). If multiple are found, there is interstitial edema.
    • If you see any comet tail artifact, there is no PTX.
  • Assess for PTX separately by scanning longitudinally in anterior 3rd IC space, mid-clavicular line.
    • Look for lack of sliding or use M-mode to look for reassuring beach sign

See Also


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