Hurry Up & RUSH!


    Hurry Up & RUSH!

    You’re working in RESUS, and you get a notification for hypotension.

    He’s a 65 year old male noted to be hypotensive to 70/40 by EMS. On arrival, he’s altered and unable to provide any history, and EMS doesn’t have much more information. You don’t see any signs of trauma.

    Your attending suggests performing a RUSH exam to help narrow down your differential.  

    The RUSH (rapid ultrasound for shock and hypotension) exam is a fairly new concept, developed in effort to rapidly evaluate the undifferentiated hypotensive patient.

    Think of the RUSH exam for critically ill medical patients (hypotensive, signs of shock) as the equivalent of the FAST on your trauma patients.

    Here’s a nice graphic from EMCrit of your typical views:


    And there’s a great pneumonic (also from EMCrit) to help remember this (especially since this is your end goal):


    HEART: look for a pericardial effusion/tamponade, RV strain (PE?), LV function (cardiogenic sources)

    IVC: evaluate the volume status and guide your fluid resuscitation decisions

    Morrison’s/FAST: You know what to do! This will help you assess for things like a ruptured ectopic, massive ascites, spontaneous ruptured AAA, perforated viscus.

    AORTA: AAA–4 views (just below heart, suprarenal, infrarenal, just before bifurcation)

    PTX: r/o tension

    So next time you’re in either Resus or the Cardiac room with a hypotensive patient, grab the ultrasound and start RUSH-ing!

    Shout out to Dr. Moira Carroll for inspiring this post!

    SOURCES: <<< you’ll note some familiar names!

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more