Rapid ultrasound in shock

Last revised by Dr Ammar Haouimi on 30 Dec 2020

The rapid ultrasound in shock (RUSH) protocol is a structured point-of-care ultrasound (POCUS) 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 hypovolemic, 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.

Protocol

The protocol 1 includes assessment of the 'pump, tank and pipes':

Findings

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 artifact in the lung due to pulmonary edema
  • 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 fat IVC and IJV
  • pleural empyema
  • peritoneal fluid (peritonitis)

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