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Use of bedside ultrasound in shock: RUSH protocol

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Use of bedside ultrasound in shock: RUSH protocol

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Use of bedside ultrasound in shock: RUSH protocol

  1. 1. Use of bedside Ultrasound in Shock RUSH Protocol DAN STEVENS, ED REG SCGH
  2. 2. RUSH Protocol  Rapid Ultrasound for Shock and Hypotension  Other protocols  ACES – Abdominal and Cardiac Evaluation (with ultrasound) in Shock  FALLS protocol - Lichtenstein  Early recognition and treatment of shock improves outcome  Bedside ultrasound in undifferentiated hypotension in the Emergency department leads to improved physician diagnosis1
  3. 3. Causes of Shock  Cardiogenic  MI  Cardiac tamponade  Hypovolaemic  Bleeding  Obstructive  PE  Pneumothorax  Distributive  Sepsis  Anaphylaxis
  4. 4. RUSH Protocol  The Pump • The Heart  The Tank • Fullness of the tank • IVC • Emptiness of the tank • EFAST  The Pipes • Leaking pipes • AAA • Blocked pipes • DVT
  5. 5. Where to Scan
  6. 6. Parasternal long axis • Pericardial effusion • Pleural effusion • LV contractility • Normal • Hyperdynamic • Reduced • RV size
  7. 7. Parasternal Short axis • RV side • Septal wall motion
  8. 8. Apical 4 chamber • RV and LV size • RV and LV function
  9. 9. Subcostal • Pericardial effusion
  10. 10. IVC view  > 2.1cm with < 50% collapse = high CVP  < 2.1cm with > 50% collapse = low CVP
  11. 11. RUQ, LUQ, PELVIS • Abdominal free fluid • Pleural effusion
  12. 12. Aorta • Aneurysm • Dissection
  13. 13. Femoral Vein +/- Popliteal • Compressible / non compressible
  14. 14. Anterior chest wall • Sliding / no sliding • Lung rockets
  15. 15. CASE 1 Hyperdynamic LV Large RV
  16. 16. Hyperdynamic LV Large RV Flattening of septum
  17. 17. RV > LV
  18. 18. Dilated IVC > 2.1cm < 50% collapse
  19. 19. Non compressible clot in Femoral Vein
  20. 20. CASE 2 Dliated LV Poorly contracting Biatrial enlargement
  21. 21. Dilated IVC > 2.1cm < 50% collapse
  22. 22. Lung rockets B lines > 3 = abnormal
  23. 23. Normal
  24. 24. Normal
  25. 25. CASE 3 Hyperdynamic ‘kissing LV’
  26. 26. IVC < 2.1cm > 50% collapse
  27. 27. Fluid in Morrisons Pouch
  28. 28. Empty uterus +ve Bhcg Fluid pouch of Douglas
  29. 29. CASE 4 Pericardial Effusion ?cardiac tamponade
  30. 30. Dilated IVC > 2.1cm < 50% collapse
  31. 31. Dissection to abdominal aorta
  32. 32. Final slide….
  33. 33. References  1 Jones AE1, Tayal VS, Sullivan DM, Kline JA. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004 Aug;32(8):1703-8.  http://emcrit.org/rush-exam/original-rush-article/  http://sinaiem.us/wp-content/uploads/2012/05/31.-Sequencing.jpeg  https://www.dtod.ne.jp/ohtablog/images/article10_pdf_003.pdf  http://emcrit.org/wp-content/uploads/2011/03/New-RUSH-Review- Article1.pdf

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