RUSH: Rapid Ultrasound in SHock in the evaluation of the critically ill

Question 1

What are the three things evaluated in RUSH?

Answer 1

PUMP
TANK
PIPES

Question 2

What is evaluated in the PUMP of RUSH?

Answer 2

The Heart-
Parasternal views (long (point to right shoulder) and short (point to left shoulder) axis)
subxiphoid view
apical view (roll patient on left, put on point of max impulse)

Question 3

What is evaluated in the TANK of RUSH?

Answer 3

IVC (long acid)
eFAST (RUQ)
eFAST (LUQ)
FAST (pelvis)
Pulmonary - for pneumothorax

Question 4

What is evaluated in the PIPES of RUSH?

Answer 4

Thoracic aorta
AAA
Femoral DVT
Popliteal DVT

Question 5

Which probes do you usually use in RUSH?

Answer 5

Phased array (good for getting between the ribs)
Curved linear (good for prettier picture- more crystals)

Question 6

What is the difference between the cardiac preset and the abdominal preset?

Answer 6

Cardiac preset: marker is on the left - point probe to the left of patient.
Abdominal preset: marker is on the right - point probe to the right of patient

Question 7

For the PUMP: What are the key physical findings you are looking for?

Answer 7

Look at the contractility (increased, decreased, nl?)
- ejection fraction (look at mitral valve slapping septum)
Looks for pericardial effuse/tamponade
Look for RV strain (enlarged RV?) look to see if any part of the wall of the heart is not moving?

Question 8

Pericardial effusion vs. pleural effusion

Answer 8

if fluid goes between heart and descending aorta (look for rat tail), it is pericardial effusion. No rat tail = pleural effusion.

Question 9

What are the finding of a pulmonary embolism?

Answer 9

see clot moving around in right ventricle (clothes in a washing machine. Dilated right ventricle (blood can’t flow out of right ventricle). R ventricle is typically 60% in size of L ventricle normally. D SHAPED SEPTUM: right ventricle pushing into Left ventricle. Also IVC should be large (backed up)

Question 10

How do you tell the difference between a bad asthma patient and a PE?

Answer 10

Bad asthma would have chronic pulmonary hypertension = will have a thick right ventricle wall. PE will have a large R ventricle with a thin wall.

Question 11

How do you tell right ventricle from left ventricle?

Answer 11

right ventricle has a moderator band: a white line that almost cuts the right ventricle in half

Question 12

For the TANK: What are the key physical findings you are looking for?

Answer 12

IVC size/respiratory dynamics
- small and collapses = hypovolemic
- large and does not collapse
eFAST exam: free intraperitoneal fluid, pleural effusio/hemothorax
pulmonary: pneumothorax, ultrasonic B lines.

Question 13

what is a mirror image artifact?

Answer 13

if you hit a bright reflective structure with air on one side - will see a mirror image on other side of diaphragm (sign lung is full of air). No mirror image = no air there - probably fluid.

Question 14

Tension pneumothorax: which probe do you use? where should it be located if it is positive? How do you check? positive findings of pneumothorax?

Answer 14

IVC kinked off. Use linear high frequency array. Air rises - pneumothorax should be at the top of the lungs. check entire side: from top to bottom. On left side go a bit to the side to avoid the heart.

positive findings = no sliding seen when breathing in. Use M mode (motion mode). Normal = see a sandy sea shore. Positive finding = bar code sign/stratesphere sign.