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