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

• 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

• Look for fluid at lung/diaphragm interface

Aorta

• If >5cm assume ruptured AAA until proven otherwise

Pulmonary

• Assess for subpleural interstitial edema
  • Scan with the abdominal probe in the upper lateral chest bilaterally
  • Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK)
    • If multiple found, there is interstitial edema
• Assess for pneumothorax
  • Scan longitudinally in anterior 2nd-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