Maverick Medical Education has a fair number of courses that center around pain management and relief techniques. Our group also teaches Point of Care Ultrasound, or POCUS, which gives medical professionals skills to better manage their patients’ care by using ultrasound technology. One of the many ways ultrasounds can be utilized is in performing RUSH exams when patients come in with indications that they may need the findings found within these steps the exam provides.
When to use RUSH
RUSH stands for Rapid Ultrasound for Shock and Hypotension and is usually implemented in the field or emergency room setting for patients with “undifferentiated hypotension” and is a much broader ultrasound protocol than FAST exams. A few potential findings may be myocardial infarction, systolic heart failure, hemorrhagic shock, pneumothorax, or more. It is meant to be a quick evaluation and is by no means exhaustive, but rather, it should be a supplement to other examination methods medical professionals may use.
Guide to RUSH
1. Preparation. Like any POCUS exam, you will want to ensure the proper positioning and placement of the patient and the transducer. The patient should be in the supine position, and the transducer should be a phased array probe.
2. Heart. Using several views, observe whether the heart is the issue for the hypotension. Is it pumping properly, or is it under stress? Is it compensating? Additionally, measuring the cardiac output will be necessary as well.
3. Inferior Vena Cava. By looking at the central venous pressure (CVP), more information will be available as to the source of the shock. Charts are available for more insight into CVP and what is within normal limits.
4. Morison’s Pouch. At this step, there is an overlap with the eFAST exam. You will be looking for leaks in the abdomen and thorax with a scan of the RUG, LUG, and pelvic views. The medical team will decide on the following treatment and observation steps by detecting free fluid.
5. Aorta. Hypotension can occur as a result of a few situations in the aorta, including abdominal aortic aneurysm or aortic dissection. Both scenarios must be ruled out quickly, as both have a high mortality rate.
6. Pulmonary. The lungs are given a check earlier in the RUSH exam and looked at closely again for the last step. This step is looking closer at pneumothorax by scanning multiple points on the chest for increased awareness of the potential issue.
There are a few limitations in performing a RUSH exam. Sometimes they are as easy as adjusting the patient’s position or your position as the examiner, although placing yourself on their right side is usually best for the person performing the ultrasound. Body habitus is also a potential limitation, with some compositions easier than others for clear measurements and views. Physical constraints, depending on the field, can also cause issues as unobstructed views are necessary for the best possible diagnoses and plans.
If you believe the POCUS course would benefit you and your practice, see our schedule for the next available time to learn more. Our courses are available immediately upon signing up, with online modules ready from any internet-connected device. We can answer any questions you have and look forward to welcoming you to our POCUS and Maverick Medical Education team.