Lesson 9 of 12
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Interpretation: The RUSH Protocol

RUSH Protocol

RUSHRapid Ultrasound in Shock and Hypotension

RUSH Protocol

Sequence of ultrasound views used in the RUSH protocol. Image From: Seif et al. Critical Care Research & Practice. 2012

The RUSH Protocol is useful for the evaluation of undifferentiated hypotension. It allows for rapid evaluation and inclusion or exclusion of common causes of shock and hypotension. It can be used in the perioperative period, peri arrest scenario and trauma setting (eFAST protocol is preferred for trauma).

HIMAP can be used as a mnemonic :

HHeart     

The FATE Protocol or FCU views can be used

Evaluate the heart for LV and RV contractility and chamber sizes 

The right ventricle is normally 1/3 the size of the left ventricle

The apex of the normal heart is formed by the left ventricle

Look for pericardial effusion or signs of cardiac tamponade (see above)

Look for large pleural effusions

IIVC

Evaluate IVC size and respiratory variation

Plethoric vs normal vs collapsed

IVC size can be measured 2cm distal to the IVC – RA junction

M Mode can be used to detect respiratory variation and for measurement

MMorisons Pouch 

Scan the RUQ and LUQ of the abdomen for free fluid.

Free Fluid in Morisons Pouch. Image shows liver on the left, kidney in the middle. Free fluid is the anechoic (black) space between liver and kidney.

AAbdominal Aorta

Abdominal Aorta can be scanned for evidence of aneurysm / rupture / dissection.

Abdominal Aorta

Dissection Flap seen in Abdominal Aorta. Sagittal and Transverse Plane. Image from Twitter@PratsEM

PPneumothorax

Scan the anterior zones of each hemithorax to evaluate for presence of a pneumothorax. This is discussed further in the Lung Ultrasound Section.

Causes of SHOCK can also be described in terms of ‘Pump Failure’ (Heart), ‘Tank’ (Intravascular Volume Status) and ‘Pipes’.

Image from: The RUSH Exam: Rapid Ultrasound in Shock in the Evaluation of the Critically Ill. Perera et al. Ultrasound Clinics N Am, 2010.

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