Rapid ultrasound in shock

Dr Henry Knipe and Dr Craig Hacking et al.

The rapid ultrasound in shock (RUSH) protocol is a structured point-of-care ultrasound (POCUS) examination performed at the time of presentation of a shocked patient. It is a more detailed and longer exam than the FAST scan, with the aim to differentiate between hypovolemic, cardiogenic, obstructive and distributive shock.

It is invariably performed by a clinician, who should be formally trained and can be considered as an 'extension' of the shock clinical assessment process, to aid rapid decision making.

Protocol

The protocol 1 includes assessment of the 'pump, tank and pipes':

Findings

Features seen in hypovolemic shock include:

  • hypercontractile heart
  • small heart size
  • flat IVC and IJV
  • pleural or peritoneal blood
  • ruptured AAA
  • aortic dissection

Features seen in cardiogenic shock include:

  • hypocontractile heart
  • dilated heart size
  • distended IVC and IJV
  • lung rockets (B-line): echogenic fan pattern of artefact in the lung due to pulmonary edema
  • pleural or peritoneal fluid (effusions, ascites)

Features seen in obstructive shock include:

  • pericardial effusion
  • RV strain
  • hypercontractile heart
  • distended IVC and IJV
  • pneumothorax
  • DVT

Features seen in distributive shock include:

  • hypocontractile heart (in late sepsis)
  • hypercontractile heart (in early sepsis)
  • normal or fat IVC and IJV
  • pleural empyema
  • peritoneal fluid (peritonitis)
Share article

Article information

rID: 44081
Section: Approach
Synonyms or Alternate Spellings:
  • RUSH

Support Radiopaedia and see fewer ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.