RUSH Protocol
RUSH – Rapid Ultrasound in Shock and Hypotension
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 :
H – Heart
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
I – IVC
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
M – Morisons 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.
A – Abdominal Aorta
Abdominal Aorta can be scanned for evidence of aneurysm / rupture / dissection.
Dissection Flap seen in Abdominal Aorta. Sagittal and Transverse Plane. Image from Twitter@PratsEM
P – Pneumothorax
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.