Difference between revisions of "Ultrasound: In Shock and Hypotension"
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+ | ==Background== | ||
+ | *Several techniques are available for differentiating shock states | ||
+ | *RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology | ||
+ | #The Pump | ||
+ | ##RV:LV | ||
+ | ##Squeeze | ||
+ | ##Pericardial effusion | ||
+ | #The Tank | ||
+ | ##IVC | ||
+ | ##Pleural effusions | ||
+ | ##Pulmonary edema | ||
+ | #The Pipes | ||
+ | ##AAA | ||
+ | ##Aortic dissection | ||
+ | ##DVT | ||
+ | |||
+ | ==The Protocol== | ||
Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach<ref>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 </ref> | Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach<ref>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 </ref> | ||
− | '''H''' - Heart (parasternal and four-chamber views) | + | *'''H''' - Heart (parasternal and four-chamber views) |
− | '''I''' - Inferior Vena Cava (for volume responsiveness) | + | *'''I''' - Inferior Vena Cava (for volume responsiveness) |
− | '''M''' - Morrison’s pouch (i.e., FAST exam) and views of thorax (looking for free fluid) | + | *'''M''' - Morrison’s pouch (i.e., FAST exam) and views of thorax (looking for free fluid) |
− | '''A''' - Aortic Aneurysm (ruptured abdominal aneurysm) | + | *'''A''' - Aortic Aneurysm (ruptured abdominal aneurysm) |
− | '''P''' - Pneumothorax (i.e., Tension PTX) | + | *'''P''' - Pneumothorax (i.e., Tension PTX) |
==Heart== | ==Heart== | ||
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==Morison's== | ==Morison's== | ||
− | * | + | Technique: see [[Ultrasound: FAST]] |
+ | *Assess for free fluid | ||
+ | **Morison's pouch | ||
+ | **Splenorenal | ||
+ | **Bladder | ||
==Aorta== | ==Aorta== |
Revision as of 14:25, 31 December 2014
Contents
Background
- Several techniques are available for differentiating shock states
- RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology
- The Pump
- RV:LV
- Squeeze
- Pericardial effusion
- The Tank
- IVC
- Pleural effusions
- Pulmonary edema
- The Pipes
- AAA
- Aortic dissection
- DVT
The Protocol
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)
Heart
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
- Walls move >90% or touch at end of systole
IVC
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
Morison's
Technique: see Ultrasound: FAST
- Assess for free fluid
- Morison's pouch
- Splenorenal
- Bladder
Aorta
Technique: see Ultrasound: Aorta
- If >5cm assume ruptured AAA until proven otherwise
Pulmonary
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
- Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK)
- Assess for pneumothorax
- Scan longitudinally in anterior 2nd-3rd IC space, mid-clavicular line
- Look for lack of sliding or "beach sign"
See Also
References
- ↑ 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