RUSH

RUSH stands for “Rapid Ultrasound for Shock and Hypotension”. It is designed to be a quick and easy to perform. The primary indication is undifferentiated hypotension.

Use a curvilinear probe with the abdominal preset exam mode to obtain the windows (Figure 1). The components of the exam can be memorized using the HI-MAP mnemonic (Figure 2).

HI-MAP = Heart IVC Morrison’s pouch Aorta Pneumothorax

• Assess for pericardial fluid and tamponade (Clip 1)
• Assess RV function (Note apical sparing and other findings consistent with pulmonary embolus)
• Assess LV function

• Long axis view
• Assess IVC diameter
• Assess IVC diameter change

• Assess free fluid within Morrison’s pouch
• Extend to full FAST when indicated

• Transducer below SX
• Indicator to patient’s right
• Aorta is circular structure right of the IVC (Figure 5)
• Scan down to from the celiac branch to the bifurcation
• Measure upper outer wall to just above vertebral body (Figure 6)
• Larger than 5 cm is abnormal, increase risk of rupture

• Bi-lateral 2nd and 4th intercostal space
• Assess lung sliding
• Look for lung point

Figure 1 - RUSH Windows

Figure 2 - HI-MAP Mnemonic

Figure 3 - IVC Windows

Figure 4 - Morrison’s Pouch/FAST Windows

Figure 5 - Aorta and IVC

Figure 6 - Measuring Aorta and IVC

Figure 7 - Pneumothorax

Clip 1 - Pericardial Tamponade

Clip 2 - IVC

Clip 3 - Pneumothorax

Seif, Dina, et al. “Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol.” Critical Care Research and Practice 2012 (2012).