The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically lll

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Classifications of shock

Many authorities categorize shock into 4 classic subtypes.8 The first is hypovolemic shock. This condition is commonly encountered in the patient who is hemorrhaging from trauma, or from a nontraumatic source of brisk bleeding such as from the gastrointestinal (GI) tract or a rupturing aortic aneurysm. Hypovolemic shock may also result from nonhemorrhagic conditions with extensive loss of body fluids, such as GI fluid loss from vomiting and diarrhea. The second subtype of shock is distributive

Shock ultrasound protocol: the RUSH exam

Given the advantages of early integration of bedside ultrasound into the diagnostic workup of the patient in shock, this article outlines an easily learned and quickly performed 3-step shock ultrasound protocol. The authors term this new ultrasound protocol the RUSH exam (Rapid Ultrasound in SHock). This protocol involves a 3-part bedside physiologic assessment simplified as:

  • Step 1: The pump

  • Step 2: The tank

  • Step 3: The pipes

This examination is performed using standard ultrasound equipment

Summary

Bedside ultrasound technology has evolved to the point that it offers a powerful, yet easy to use tool for the clinician faced with a critical patient. The initial imaging focus of ultrasound as used by Radiologists was on anatomy and pathology. Now with clinicians actively using this technology at the bedside, attention has shifted to the crucial evaluation of physiology. The ability to recognize both abnormal pathology and physiology in a critical patient, recognize a distinctive shock state,

Acknowledgments

We would like to acknowledge the work of Scott Weingart, MD and Brett Nelson, MD on ultrasound evaluation of the hypotensive patient.

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