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

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 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

• Ultrasound (Main)
• Shock

Source

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