Rapid ultrasound in shock
Updates to Article Attributes
The Rapid ultrasound in shock (RUSH) protocol is a structured point-of-care ultrasound examination performed at the time of presentation of a shocked patient. It is a more detailed and longer exam than the FAST scan, with the aim to differentiate between hypovolaemichypovolemic, cardiogenic, obstructive and distributive shock.
It is invariably performed by a clinician, who should be formally trained, and can be considered as an 'extension' of the shock clinical assessment process, to aid rapid decision making.
The protocol 1 includes assessment of the 'pump, tank and pipes':
- the pump: the heart
- pericardial effusion
- signs of tamponade
- left ventricular (LV) contractility
- signs of right ventricular (RV) strain
- the tank: the lungs
-
inferior vena cava (IVC) volume and
collpasecollapse with inspiration - internal jugular vein (IJV) volume
- free fluid in pleural or peritoneal spaces
- pulmonary oedema
- tension pneumothorax
-
inferior vena cava (IVC) volume and
- the pipe: the vessels
- abdominal aortic aneurysm (AAA) or dissection
- thoracic aortic aneurysm or dissection
- lower limb deep vein thrombosis (DVT) (as a source of pulmonary embolus (PE))
Features seen in hypovolemic shock include:
- hypercontractile heart
- small heart size
- flat IVC and IJV
- pleural or peritoneal blood
- ruptured AAA
- aortic dissection
Features seen in cardiogenic shock include:
- hypocontractile heart
- dilated heart size
- distended IVC and IJV
- lung rockets (B-line): echogenic fan pattern of
artifactartefact in the lung due to pulmonary oedema - pleural or peritoneal fluid (effusions, ascites)
Features seen in obstructive shock include:
- pericardial effusion
- RV strain
- hypercontractile heart
- distended IVC and IJV
- pneumothorax
- DVT
Features seen in distributive shock include:
- hypocontractile heart (in late sepsis)
- hypercontractile heart (in early sepsis)
- normal or falt IVC and IJV
- pleural empyema
- peritoneal fluid (peritonitis)
Reference and inspiration courtesy of Dr Frances EM Williamson, a sonographically trained emergency physician.
-<p>The <strong>Rapid ultrasound in shock (RUSH)</strong> protocol is a structured point-of-care ultrasound examination performed at the time of presentation of a shocked patient. It is a more detailed and longer exam than the <a href="/articles/focussed-assessment-with-sonography-for-trauma-fast-scan">FAST scan</a>, with the aim to differentiate between hypovolaemic, cardiogenic, obstructive and distributive shock.</p><p>It is invariably performed by a clinician, who should be formally trained, and can be considered as an 'extension' of the shock clinical assessment process, to aid rapid decision making.</p><p>The protocol <sup>1</sup> includes assessment of the 'pump, tank and pipes':</p><ul>- +<p>The <strong>Rapid ultrasound in shock (RUSH)</strong> protocol is a structured point-of-care ultrasound examination performed at the time of presentation of a shocked patient. It is a more detailed and longer exam than the <a href="/articles/focussed-assessment-with-sonography-for-trauma-fast-scan">FAST scan</a>, with the aim to differentiate between hypovolemic, cardiogenic, obstructive and distributive shock.</p><p>It is invariably performed by a clinician, who should be formally trained, and can be considered as an 'extension' of the shock clinical assessment process, to aid rapid decision making.</p><p>The protocol <sup>1</sup> includes assessment of the 'pump, tank and pipes':</p><ul>
-<a href="/articles/inferior-vena-cava-ivc">inferior vena cava (IVC) </a>volume and collpase with inspiration</li>- +<a href="/articles/inferior-vena-cava-ivc">inferior vena cava (IVC) </a>volume and collapse with inspiration</li>
-<li>lung rockets (B-line): echogenic fan pattern of artifact in the lung due to pulmonary oedema</li>- +<li>lung rockets (B-line): echogenic fan pattern of artefact in the lung due to pulmonary oedema</li>