RUSH (Rapid Ultrasound in Shock and Hypotension) protocol.

RUSH (Rapid Ultrasound in Shock and Hypotension) protocol

Who uses the RUSH protocol? 
Intensive care units, emergency medicine doctors, and radiologists.

Objective: shortening and simplifying the ultrasound examination to enable us to rapidly find and/or exclude potential causes of hemodynamic instability. We perform the RUSH exam in a specific sequence, which can be recalled using the mnemonic HI MAP (Heart, IVC, Morrison’s pouch and the FAST exam with hemothorax windows, Aorta, Pneumothorax). 
The ultrasound transducer should be applied in 9 places:
1. We start with a cardiac examination in two projections, longitudinal, retrosternal and four-chamber. In these projections, we assess three parameters: the presence of fluid in the pericardial sac, right ventricular dilatation and left ventricular contractility. Visualisation of the abnormality can shed light on the causes of cardiac shock, such as myocardial infarction or tamponade, or in the case of right ventricular dilatatio,pulmonary embolism. 2. Next, shift to visualisation of IVC (Inferior vena cava). Measurement of the IVC diameter and its collapsibility during inhalation provides an approximate assessment of vascular bed filling. 3. We continue on to hepatorenal (Morrison's) 4. and spleno-renal abnormalities to check for presence of fluid, which would suggest abdominal haemorrhage. 5. Now we tilt the head towards the diaphragm. This is to additionally examine for the presence of any fluid in the pleural cavity in the diaphragmatic angle. 6. Next, apply the probe to the suprapubic region to visualise the urinary bladder and vesico-rectal pouch in men or utero-rectal (Douglas) pouch in women. The presence of fluid in this location indicates bleeding into the pelvis, which may be a complication of, for example, ectopic pregnancy. 7. Subsequently, we examine the abdominal aorta throughout its course for aneurysms. 8. The last two points are the intercostal spaces on the right side, 9. and the left side in the anterior axillary line. In these places we confirm or exclude pneumothorax. Assessment: in order to facilitate the order and division of the tested systems, they were divided into: 1. Pump - blood pressure system 2. Tank - blood collection system 3. Pipes - blood conduction system. Accordingly, pathology may appear in these systems: Pump: Presence of fluid in the pericardial sac, pericardial tamponade features, left ventricular contractility, right ventricular size and function, aortic diameter. Tank: The filling of the vascular bed; diameter and respiratory variability of dimensions of the inferior vena cava are assessed; assessment of the abdominal cavity and lungs according to the eFAST protocol - diagnostics for free fluid in the peritoneal and pleural cavities. Pipes: Diagnostics for rupture, dissection of abdominal and thoracic aortic aneurysms; venous thrombosis of the lower extremities, compression test of venous vessels suspected of having thrombi.

 

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