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?

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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:

  1. Heart (PSL, A4C) – assess for pericardial effusion/tamponade, RV failure (consider massive PE or RV infarction), LV function (hypo vs hyperdynamic)
  2. IVC – assess volume status
  3. Morrison’s (FAST) – assess for free fluid
  4. Aorta – assess for AAA
  5. Pneumothorax – assess both sides

[1]

In a recently published study (Ghane et al., 2015), 77 patients were assessed by RUSH protocol by either one EP or one radiologist. [2] 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.

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Sources:

1) http://sinaiem.us/tutorials/rush

2) Ghane MR et al. Accuracy of RUSH exam for diagnosis of shock in critically ill patients. Trauma Mon. 2015 Feb;20(1):e20095.