Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol US Imaging – Illustrations

May 29, 2020June 7, 2020 ~ Murat Yazici, Turkey ~ Leave a comment

Patients with hypotension or shock have high mortality rates, and traditional physical exam techniques can be misleading. Diagnosis and initial care must be accurate and prompt to optimize patient care. Ultrasound is ideal for evaluating critically ill patients in shock, and ACEP guidelines now delineate a new category of ultrasound (US)– “resuscitative.” Bedside US allows for direct visualization of pathology and differentiation of shock states (1). The RUSH is one of the most commonly used protocols for this purpose.

The RUSH exam involves a 3-part bedside physiologic assessment simplified as “the pump,” “the tank,” and “the pipes” (2).

Pump

Tank

Pipes

References and Further Reading

By Organ System or Specialty Archives | Page 84 of 123 | ALiEM. https://www.aliem.com/category/emergency-medicine-clinical/system/page/84/
Seif D1, Perera P, Mailhot T, Riley D, Mandavia D. “Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol” Crit Care Res Pract. 2012;2012:503254.
https://iem-student.org/2020/02/14/lower-extremity-deep-venous-us-imaging-illustrations/
https://iem-student.org/rush/
https://iem-student.org/efast/

Cite this article as: Murat Yazici, Turkey, "Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol US Imaging – Illustrations," in International Emergency Medicine Education Project, May 29, 2020, https://iem-student.org/2020/05/29/rush-protocol-illustrations/, date accessed: April 19, 2024

RUSH Course for Medical Students

May 27, 2020July 10, 2020 ~ Arif Alper Cevik ~ Leave a comment

Dear students,

We are pleased to open our third course for you; Rapid Ultrasound in Shock and Hypotension (RUSH).

As a part of our social responsibility initiative, iem-course.org will continue to provide free open online courses related to emergency medicine. We hope our courses help you to continue your education during these difficult times.

Please send us your feedback or requests about courses.

We are here to help you.

Best regards.

Arif Alper Cevik, MD, FEMAT, FIFEM

iEM Course is a social responsibility initiative of iEM Education Project

Hypotension is a high-risk sign which is associated with increased morbidity and mortality rate. The differential diagnosis for hypotension is broad and the treatment depends on the underlying etiology. In most cases of hypotension, patients present with limited history and physical examination may be inaccurate making the management of the condition a great challenge for emergency physicians.

The use of POCUS in undifferentiated hypotension has been shown to help correctly and rapidly identify the etiology and therefore initiate the appropriate management. Since 2001, there are many protocols published describing a systematic approach to the use of POCUS in undifferentiated hypotension.

In this course, we will focus on the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol.

This course aims to provide the necessary information on ultrasonography, its use in a hypotensive patient, and to prepare you for a RUSH practice session.

The course content is prepared and curated from iEM Education chapters, iEM image and video archives, and various FOAMed resources.

At the end of this course, you will be able to;

Describe the basics of ultrasound (terminology, knobology, image acquisition, artifacts, etc.)
Describe indications of RUSH protocol
Describe patient and machine preparations
Describe ultrasound examination views
Recognize normal anatomical structures
Recognize abnormal findings
Feel confident to take a practical session for RUSH protocol

Who can get benefit from this course?

Junior and senior medical students (course specifically designed for these groups)
Interns/Junior emergency medicine residents/registrars

Other Free Online Courses

Cite this article as: Arif Alper Cevik, "RUSH Course for Medical Students," in International Emergency Medicine Education Project, May 27, 2020, https://iem-student.org/2020/05/27/rush-course-for-medical-students/, date accessed: April 19, 2024

Lower Extremity Deep Venous US Imaging – Illustrations

February 14, 2020February 8, 2020 ~ Murat Yazici, Turkey ~ Leave a comment

Ultrasound evaluation for deep venous thrombosis (DVT) is one of the 11 core ultrasound applications for emergency physicians as listed in the 2008 American College of Emergency Physicians guidelines (1). Because ultrasound applications started to be implemented into medical school curriculum in many countries, learning basic ultrasound applications as early as possible will benefit medical students and junior residents. In this post, I will share lower extremity venous ultrasound illustrations with you.

Indications

The clinical indications for performing a lower venous ultrasound examination is the suspicion of a lower extremity DVT in a swollen or discoloured leg.

Transducer

Select a high-frequency linear transducer, (5-10) MHz transducer since it provides optimal venous copmression and image resolution.

Remember Risk Factors of DVT

Age > 60
Cancer
Central venous catheter/insertion
Genetic causes of hypercoagulopaty
History of DVT
Immobilization
Obesity
Pregnancy
Smoking
Trauma or recent surgery
Use of birth control pills or hormone replacement therapy

Wells Score for Deep Vein Thrombosis

Criteria	Score
Active cancer(treatment ongoing or within previous 6 months or palliative treatment)	1
Paralysis, paresis, or recent plaster immobilization or of the lower extremities	1
Recently bedridden for 3 days or more or major surgery within the previous 12 weeks requiring general or regional anesthesia	1
Localized tenderness along the distribution of the deep venous system	1
Entire leg swollen	1
Calf swelling > 3cm compared to asymptomatic leg (measuring 10 cm below tibial tuberosity)	1
Pitting edema confined to the symptomatic leg	1
Non varicose collateral superficial veins	1
Previously documented DVT	1
Alternative diagnosis at least as likely as DVT	1

Normal DVT Ultrasound Findings

Reference and Further Reading

American College of Emergency Physicians. Emergency ultrasound guidelines 2008. http://www.acep.org/WorkArea/DownloadAsset.aspx?ID=32878. February 2012.

Note: Visual drawings are inspired by the Point-of-Care ULTRASOUND Book.

Cite this article as: Murat Yazici, Turkey, "Lower Extremity Deep Venous US Imaging – Illustrations," in International Emergency Medicine Education Project, February 14, 2020, https://iem-student.org/2020/02/14/lower-extremity-deep-venous-us-imaging-illustrations/, date accessed: April 19, 2024

Hepatobiliary US Imaging – Illustrations

November 27, 2019November 25, 2019 ~ Murat Yazici, Turkey ~ Leave a comment

Anatomy Of The Hepatobiliary System

Indications

Indications for clinicians to perform point-of-care hepatobiliary ultrasound include the evaluation of; abdominal pain, jaundice, sepsis and ascites.

Transducer

The most commonly used positions include; left lateral decubitus and supine position. A low-to medium-frequency (2–5 MHz) curvilinear ultrasound transducer will suffice for most ultrasound examinations of the gallbladder.

Patient positioning

Patient positioning plays a vital role in the hepatobiliary ultrasound examination. Transducer position according to gallbladder; longitudinal and transverse.

Focus Points on Hepatobilary Ultrasound

Patient Position and Transducer Position

Normal Hepatobiliary Ultrasound Findings

Pathological Hepatobiliary Ultrasound Findings

Cite this article as: Murat Yazici, Turkey, "Hepatobiliary US Imaging – Illustrations," in International Emergency Medicine Education Project, November 27, 2019, https://iem-student.org/2019/11/27/hepatobiliary-us-imaging-illustrations/, date accessed: April 19, 2024