Thread by @Pocus101

Hypotensive Patient Got you Stumped 🙄? Learn the RUSH Exam 🚀 to Solve the Problem! #POCUS

Learn:
1⃣What the RUSH Exam is
2⃣The HI MAP Mnemonic
3⃣Ultrasound pathology that causes Hypotension

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🔗👉pocus101.com/RUSH

#medtweetorial 👇 (1/n)

The RUSH (Rapid Ultrasound for Shock and Hypotension) Exam was first described in 2006 by Weingart et al using the "HI MAP" Mnemonic.

HI MAP Stands for

Heart
IVC
Morison's Pouch (eFAST exam)
Aorta
Pulmonary

Attached is a table that summarizes the pathology you may find in each system. Check out the full blog post for more details!

🔗👉pocus101.com/RUSH

For the Heart you can look for

1 Ejection Fraction
2 Pericardial Effusion/Tamponade
3 RV Strain
4 Regional Wall Motion Abnormality
5 Cardiac Output

🔗👉pocus101.com/RUSH

Here is an example of a severely Reduced EF.

🔗👉pocus101.com/RUSH

Here is an example of Pericardial Effusion and Tamponade

🔗👉pocus101.com/RUSH

For RV Strain you can look for McConnell's Sign with RV hypokinesis and apical sparing

🔗👉pocus101.com/RUSH

RV Strain can also show up as the D Sign

🔗👉pocus101.com/RUSH

If you do see RV Strain you should also proceed to see if the patient has a DVT. Download the Pocket Card in the link below:

🔗👉pocus101.com/DVT

For more advanced users you can also measure the cardiac output of the patient to further differentiate the type of shock. Download the Pocket Card in the link below:

🔗👉pocus101.com/CardiacOutput

Next look at the IVC and to estimate the CVP

🔗👉pocus101.com/RUSH

Here is a Small and Collapsible IVC

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Here is Dilated and Noncollapsible IVC

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After you get the LV Ejection Fraction, IVC, and Cardiac output you can integrate these findings to help further figure out what type of shock your patient is in.

🔗👉pocus101.com/RUSH

Next look at Morison's Pouch (i.e. eFAST Exam) to evaluate for Hemoperitoneum or Hemothorax.

🔗👉pocus101.com/RUSH

Here is example of free fluid in Morison's Pouch of the RUQ

🔗👉pocus101.com/RUSH

For hemothorax look for the extension of the spine sign above the diaphragm.

🔗👉pocus101.com/RUSH

Next look at the aorta for ruptured AAA or Aortic Dissection. Here is an example of AAA.

🔗👉pocus101.com/RUSH

And here is an example of aortic dissection in the abdominal aorta in the longitudinal view.

🔗👉pocus101.com/RUSH

Lastly look for Pneumothorax as a cause of Hypotension by looking for the absence of lung sliding.

🔗👉pocus101.com/RUSH

If there is no lung sliding make sure to look for the lung point sign to confirm a pneumothorax is present!

🔗👉pocus101.com/RUSH

@AMinalyan