The main indication of the RUSH Ultrasound Exam is to quickly assess any patient with undifferentiated Shock and Hypotension.
Here is a simple to table that summarizes the pathology that may be encountered using the HI MAP Mnemonic of the RUSH Exam Ultrasound Protocol.
|H||Heart||Ejection Fraction (Reduced) -> Systolic Heart Failure|
Ejection Fraction (Hyperdynamic) -> Distributive or Hypovolemic Shock
Pericardial Effusion -> Tamponade
Right Ventricular (RV) Strain -> Pulmonary Embolism (PE)
Regional Wall Motion Abnormality -> Myocardial Infarction
Low Cardiac Output -> Cardiogenic, Hypovolemic, or Obstructive Shock
High Cardiac Output -> Distributive Shock
|I||Inferior Vena Cava (IVC)||IVC Collapsible -> Hypovolemic or Distributive Shock|
IVC Non-collapsible -> Obstructive or Cardiogenic Shock
|M||Morison’s/eFAST Exam||Hemoperitoneum/Hemothorax -> Hemorrhagic Shock|
|A||Aorta||Abdominal Aortic Aneurysm|
It is important to remember that the RUSH exam is not a comprehensive assessment of every component listed, but rather a quick evaluation for the major pathologies that can cause hypotension (and shock) in a patient. Once practiced, this exam can be completed in as little as 2-5 minutes.
Limitations faced by this protocol are those faced by any ultrasound examination: body habitus, patient positioning, and physical constraints that make ideal imaging difficult.