Ultrasound: in shock and hypotension - Revision history

Danbot: Danbot moved page Ultrasound: In Shock and Hypotension to Ultrasound: in shock and hypotension without leaving a redirect: Naming convention: first word capitalized, subsequent words lowercase

2026-03-22T05:35:01Z

Danbot moved page Ultrasound: In Shock and Hypotension to Ultrasound: in shock and hypotension without leaving a redirect: Naming convention: first word capitalized, subsequent words lowercase

← Revisión anterior	Revisión del 05:35 22 mar 2026
(Sin diferencias)

Rossdonaldson1: /* See Also */

2024-03-27T22:06:32Z

Rossdonaldson1: /* Video */

2024-03-27T22:06:16Z

Video

← Revisión anterior		Revisión del 22:06 27 mar 2024
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	==Other==		==Other==
	{{Ultrasound findings for critically ill patients table}}		{{Ultrasound findings for critically ill patients table}}

	~~==Video==~~
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	==See Also==		==See Also==

Patricklin at 01:17, 20 March 2024

2024-03-20T01:17:15Z

← Revisión anterior		Revisión del 01:17 20 mar 2024
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	==Background==		==Background==
	*~~Several techniques are available~~ for differentiating shock states		*A bedside ultrasound paradigm for differentiating differentiating shock states (cardiogenic, obstructive, hypovolemic, distributive)
	*RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology<ref>Weingart - https://emcrit.org/rush-exam/</ref>		**Tailor specific protocol to the patient at hand
			*RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology<ref>Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am. 2010 Feb;28(1):29-56, vii. doi: 10.1016/j.emc.2009.09.010. PMID: 19945597.</ref><ref>Weingart - https://emcrit.org/rush-exam/</ref>
	#The Pump		#The Pump
	#*RV:LV		#*RV:LV
	#*Squeeze		#*Squeeze
	#*[[Pericardial effusion]]		#*[[Pericardial effusion and tamponade]]
	#The Tank		#The Tank
	#*IVC		#*IVC
	#*[[Pleural effusions]]		#*[[Pleural effusions]]
	#*[[Pulmonary edema]]		#*[[Pulmonary edema]]
			#*[[Tension pneumothorax]]
	#The Pipes		#The Pipes
	#*[[AAA]]		#*[[AAA]]
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	Technique: see [[Cardiac ultrasound]]		Technique: see [[Cardiac ultrasound]]
	*Pericardial Effusion		*Pericardial Effusion
	**~~Parasternal long~~		**May be most obvious with PLAX or subxiphoid views<ref>Alerhand S, Carter JM. What echocardiographic findings suggest a pericardial effusion is causing tamponade? Am J Emerg Med. 2019 Feb;37(2):321-326. doi: 10.1016/j.ajem.2018.11.004. Epub 2018 Nov 17. PMID: 30471929.</ref>
			***In PLAX, pericardial fluid is anterior to descending aorta, while pleural fluid is posterior to it
			**Isolated anterior anechoic areas may be an anterior fat pad
			**Assess for tamponade physiology including diastolic collapse of RA or RV; see [[Pericardial effusion and tamponade]]
			*LV squeeze
			**PLAX and PSAX are good views to estimate contractility
	**Change in size <30% between sys and dia = poor LV function		**Change in size <30% between sys and dia = poor LV function
	*RV ~~collapse~~		**Hyperdynamicity, as determined by walls moving >90% or touching at end of systole, may indicate hypovolemia or sepsis
	**In 4-chamber view, RV should be <60% of LV; if larger think RV ~~failure~~		**May direct fluid therapy
	*~~Hyperdynamicity~~		*RV strain
	**Walls move >90% or touch at end of systole		**In 4-chamber view, RV should be <60% of LV; if dilated/larger think RV strain
	***May indicate hypovolemia or sepsis		**While chronic RV strain (ex. cor pulmonale) may cause RVH, massive PE will not have time to cause RVH

	==IVC==		==IVC==
	Technique: see [[IVC ultrasound]]		Technique: see [[IVC ultrasound]]
	*Measure 2cm from RA-IVC junction		*Measure 2cm caudally from RA-IVC junction
	*If IVC <1.~~5cm~~ and collapses on inspiration then CVP is low		*If IVC <2.1cm and collapses >50% on inspiration then RAP/CVP is low<ref>Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):685-713; quiz 786-8. doi: 10.1016/j.echo.2010.05.010. PMID: 20620859.</ref>
	*If IVC >2.~~5cm~~ and ~~noncollapsing~~ then CVP is high		*If IVC >2.1cm and collapses <50% then RAP/CVP is high
	**Suggests fluid unresponsive; patient requires inotropes		**Suggests fluid unresponsive; patient requires inotropes
			*IVC measurements may be altered in patients receiving vasoactive medications or positive pressure ventilation

	==Morison's==		==Morison's==
	Technique: see [[FAST exam]]		Technique: see [[FAST exam]]
	*Assess for free fluid		*Assess for free fluid
	**Morison's pouch		**Morison's pouch (hepatorenal space)
	**Splenorenal		**Splenorenal
	**Bladder		**Bladder, including retrovesicular space
			**As part of E-FAST, when in hepatorenal or splenorenal views, aim/slide probe above diaphragm to assess for pleural effusion
			*Note that while ascitic fluid often appears anechoic, blood may appear with mixed echogenicity due to the presence of clots

	==Aorta==		==Aorta==
	Technique: see [[Aortic ultrasound]]		Technique: see [[Aortic ultrasound]]
			*Steady pressure with probe can displace bowel gas, improving view
	*If >5cm assume ruptured AAA until proven otherwise		*If >5cm assume ruptured AAA until proven otherwise
			*In PLAX, aortic root >3.8cm may be seen in proximal aortic dissection or aortic aneurysm<ref>Seif D, 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. doi: 10.1155/2012/503254. Epub 2012 Oct 24. PMID: 23133747; PMCID: PMC3485910.</ref>

	==Pulmonary==		==Pulmonary==
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	*Assess for subpleural interstitial edema		*Assess for subpleural interstitial edema
	**Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK)		**Look for multiple comet tail artifacts or "B lines"(a few, 3-4, are OK)
	***If multiple found, there is interstitial edema		***If multiple found, there is interstitial pulmonary edema
	*Assess for pneumothorax		*Assess for pneumothorax
	**Scan longitudinally in anterior 2nd-3rd IC space, mid-clavicular line		**Scan longitudinally in anterior 2nd-3rd IC space, mid-clavicular line, looking for echogenic pleural line
	**~~Look~~ for lack of sliding or "~~beach~~ sign"		**On M-mode, look for lack of pleural sliding, aka "Barcode sign"
			**Presence of lung point is highly specific for PTX

	==Other==		==Other==

Hoxbox: /* Background */

2020-12-12T14:14:46Z

Background

← Revisión anterior		Revisión del 14:14 12 dic 2020
Línea 1:		Línea 1:
	==Background==		==Background==
	*Several techniques are available for differentiating shock states		*Several techniques are available for differentiating shock states
	*RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology<ref>Weingart - ~~http~~://emcrit.org/~~ultrasound~~/~~The%20RUSH%20Examfinal.htm~~</ref>		*RUSH Protocol was conceived in 2008 and looks are 3 basic aspects of physiology<ref>Weingart - https://emcrit.org/rush-exam/</ref>
	#The Pump		#The Pump
	#*RV:LV		#*RV:LV

Mholtz at 17:52, 27 June 2017

2017-06-27T17:52:42Z

← Revisión anterior		Revisión del 17:52 27 jun 2017
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	==See Also==		==See Also==
	*[[Ultrasound (~~Main~~)]]		*[[Ultrasound (main)]]
	*[[~~Shock~~]]		*[[Undifferentiated shock]]

	==References==		==References==

Ostermayer: Text replacement - "Hypotension " to "Hypotension"

2017-03-10T15:01:44Z

Text replacement - "Hypotension " to "Hypotension"

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	[[File:Step 2.png\|thumb\|Step 2: The Tank]]		[[File:Step 2.png\|thumb\|Step 2: The Tank]]
	[[File:Step 3.png\|thumb\|Step 3: The Pipes]]		[[File:Step 3.png\|thumb\|Step 3: The Pipes]]
	Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach<ref>Dina Seif. Bedside Ultrasound in Resuscitation and the Rapid Ultrasound		Rapid Ultrasound for Shock and [[Hypotension]](RUSH) using the HI-MAP approach<ref>Dina Seif. Bedside Ultrasound in Resuscitation and the Rapid Ultrasound
	in Shock Protocol Critical Care Research and Practice Vol 2012 http://downloads.hindawi.com/journals/ccrp/2012/503254.pdf </ref>		in Shock Protocol Critical Care Research and Practice Vol 2012 http://downloads.hindawi.com/journals/ccrp/2012/503254.pdf </ref>

Neil.m.young: Text replacement - "Ultrasound: Cardiac" to "Cardiac ultrasound"

2017-03-04T14:14:17Z

Text replacement - "Ultrasound: Cardiac" to "Cardiac ultrasound"

← Revisión anterior		Revisión del 14:14 4 mar 2017
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	==Heart==		==Heart==
	Technique: see [[~~Ultrasound:~~ Cardiac]]		Technique: see [[Cardiac ultrasound]]
	*Pericardial Effusion		*Pericardial Effusion
	**Parasternal long		**Parasternal long

Rossdonaldson1: Text replacement - "PTX" to "pneumothorax"

2016-08-01T06:59:25Z

Text replacement - "PTX" to "pneumothorax"

← Revisión anterior		Revisión del 06:59 1 ago 2016
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	*'''M''' - Morison’s pouch (i.e., FAST exam) and views of thorax (looking for free fluid)		*'''M''' - Morison’s pouch (i.e., FAST exam) and views of thorax (looking for free fluid)
	*'''A''' - Aortic Aneurysm (ruptured abdominal aneurysm)		*'''A''' - Aortic Aneurysm (ruptured abdominal aneurysm)
	*'''P''' - Pneumothorax (i.e., Tension ~~PTX~~)		*'''P''' - Pneumothorax (i.e., Tension pneumothorax)

	==Heart==		==Heart==

Neil.m.young: Text replacement - "Ultrasound: IVC" to "IVC ultrasound"

2016-07-26T13:57:41Z

Text replacement - "Ultrasound: IVC" to "IVC ultrasound"

← Revisión anterior		Revisión del 13:57 26 jul 2016
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	==IVC==		==IVC==
	Technique: see [[~~Ultrasound:~~ IVC]]		Technique: see [[IVC ultrasound]]
	*Measure 2cm from RA-IVC junction		*Measure 2cm from RA-IVC junction
	*If IVC <1.5cm and collapses on inspiration then CVP is low		*If IVC <1.5cm and collapses on inspiration then CVP is low

← Revisión anterior		Revisión del 22:06 27 mar 2024
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	*[[Ultrasound (main)]]		*[[Ultrasound (main)]]
	*[[Undifferentiated shock]]		*[[Undifferentiated shock]]

			==External Links==

	==References==		==References==