Ultrasound: In Shock and Hypotension: Difference between revisions

Revision as of 02:09, 11 May 2011

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

Authors:

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 Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach
+==Heart==
+*Pericardial Effusion
-==H – Heart==
+**Parasternal long
+**Change in size <30% between sys and dia = poor LV function
+*RV collapse
-Pericardial effusion can be seen with parasternal long view. LV assessment is also from the parasternal long view. A change in size less than 30% between systole and diastole indicates poor LV function. Alternatively, the LV is hyperdynamic if walls move more than 90% or touch at the end of systole, which can happen with hypovolemia or sepsis.
+**In 4-chamber view, RV should be <60% of LV; if larger think RV failure
-In four-chamber view, RV should  be <60% of LV size – when RV is about the same size or larger than LV, think RV failure.
-  ==I – IVC==
-Start with the probe longitudinal and subxiphoid and slide  1-2 cm to the patient’s right. Look at IVC changes to inspiration. If the IVC is less than 1.5 cm and collapses on inspiration, the CVP is low and the patient probably needs fluid. A larger (>2.5cm) noncollapsing IVC suggests high CVP and the patient’s hypotension may require inotropes or reducing afterload.
-**Note: IVC assessment in vented patients requires a tidal volume of 10 mL/kg during the exam. A change in [(inspiratory size – expiratory size) / expiratory size] > 18% predicts good response to IVF.
-==M – Morison's==
-the familiar Morison’s pouch and FAST views, covered in Ultrasound Basics. Tilting the probe chestward can show fluid at the lung/diaphragm interface.
-==A – Aorta==
-The aorta (also covered in ultrasound basics) can be seen in cross section sliding down from the subxiphoid to the umbilicus. If the aorta is larger than 5 cm below the heart or in the suprarenal, infrarenal or bifurcation views, you must assume ruptured AAA.
+==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
-==P – Pneumothorax==
+==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
-PTX can be seen by ultrasound. Using a high-frequency  probe, scan longitudinally in both anterior 3rd intercostal spaces
-using M-mode. Finding an ocean/beach or seashore sign reassures that there is no pneumothorax under the probe (immobile soft tissue and
-muscle on the top of the M-mode image looks like an ocean, and the sliding lung tissue looks on the bottom looks like a beach). If the
-whole image looks like the ocean pattern (stratosphere sign), a pneumothorax is likely.
 ==Source==
+Weingart - http://emcrit.org/ultrasound/The%20RUSH%20Examfinal.htm
-Adapted from Scott Weingart and others -- http://emcrit.org/ultrasound/The%20RUSH%20Examfinal.htm
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