An 80-year-old male is brought by family for AMS. On initial assessment: BP 86/45, HR 160s, in AFib, tachypneic. While addressing the ABCs, you’re also wondering what diagnostics can be performed immediately to help evaluate this undifferentiated sick patient. Your colleague recommends the RUSH exam, but what is that?
RUSH stands for Rapid Ultrasound for Shock and Hypotension can be performed within minutes to quickly assess for life-threatening conditions.
The mnemonic “HI-MAP” identifies the sequence of necessary ultrasound views, as follows:
- Heart (PSL, A4C) – assess for pericardial effusion/tamponade, RV failure (consider massive PE or RV infarction), LV function (hypo vs hyperdynamic)
- IVC – assess volume status
- Morrison’s (FAST) – assess for free fluid
- Aorta – assess for AAA
- Pneumothorax – assess both sides
In a recently published study (Ghane et al., 2015), 77 patients were assessed by RUSH protocol by either one EP or one radiologist.  The initial impression based on RUSH exam was compared to final diagnosis. Patients with hypovolemic/cardiogenic/obstructive shock: NPV = 97-100%, PPV 89-95%. Patients with distributive shock: PPV 100%, sensitivity 73%.
Similar results in the EP and radiologist.
2) Ghane MR et al. Accuracy of RUSH exam for diagnosis of shock in critically ill patients. Trauma Mon. 2015 Feb;20(1):e20095.