Understanding the RUSH Exam

First introduced in 2006 by Weingart SD, the RUSH (Rapid Ultrasound in SHock) exam has been instrumental in the early evaluation of a hypotension or shock. It was designed to be used with the portable ultrasound machines found in the majority of emergency room and critical care facilities. The RUSH approach is used to examine the heart, inferior vena cava, Morison’s/FAST abdominal views with thoracic windows, aorta, and pneumothorax scanning.

Because understanding RUSH is so important, National Ultrasound was recently a part of a webinar hosted by GE and led by renown Professor of Emergency Medicine, Dr. Christian Fox, shared updates and instruction for managing critically ill patients.

There are several components of a RUSH exam, and each play an important part in ascertaining a patient’s status. These following 6 areas are included in RUSH:

Heart

During a RUSH exam, the heart is checked for ventricular failure or an assessment of the functionality. Echocardiographic views of the heart’s 4 chambers give the doctors more information so they know how best to proceed.

Pericardial Tamponade

When one is in shock or experiencing hypotension, there is more pericardial fluid which can cause one to suspect pericardial tamponade. However, by using RUSH, one can determine more specifically if there is a collapse in the right atrium during diastole and the right ventricle during early diastole. If tamponade is determined, then the ultrasound will also be able to detect pericardiocentesis.

Right Ventricular Enlargement

An enlarged right ventricle often occurs when one goes into shock, and a RUSH exam will identify this sooner rather than later. Should the right ventricle (RV) size equal or be large than the left, then chances are the right ventricle has failed; however, the problem may also be due to right ventricle infarction. Again, the ultrasound will make a determination of cause much quicker and clearer.

Hypodynamic Left Ventricle

In the case of hypotension, assessing the left ventricle (LV) can determine if the problem is due to infarction or myopathy, or a secondary problem such as sepsis or toxins.  As one uses the RUSH ultrasound approach, it becomes easier and faster to identify what problem needs to treated.

Hyperdynamic Left Ventricle

If during an echocardiogram, it is determined that the left ventricular walls change by more than 90% or if they actually touch at the end systole, then the LV is hyperdynamic.  This is also seen in hypovolemia, acute blood loss, and often in sepsis prior to the administration of vasopressors.

Inferior Vena Cava

The RUSH evaluation can also determine the volume status of the patient based on filling pressures during respiration. The examine will be done differently, depending on whether the patient is spontaneously breathing or receiving mandatory breaths from a ventilator.

Caring for a patient with shock can be one of the most challenging jobs in the ER medicine, and being able to make a quick assessment is a must. Understanding fully how to implement the RUSH exam approach has saved countless lives in the last decade.

If you have questions about RUSH or how to use with your specific type of ultrasound, then don’t hesitate to contact National Ultrasound or spend some time listening to the recent webinar hosted by GE.