The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically lll

Perera, Phillips; Mailhot, Thomas; Riley, David C.; Mandavia, Diku

doi:10.1016/j.emc.2009.09.010

Cited by 538 publications

(268 citation statements)

References 107 publications

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“…Assessment of patients in cardiac arrest and with undifferentiated hypotension are core applications of PoCUS, with various protocols in widespread use in emergency medicine. 2,3 Previously published protocols are based upon a logical approach to identifying the likely etiology and guiding therapy, but these protocols are frequently based solely on expert opinion and not on the actual incidence of disease, and tend to follow a didactic rigid approach. [4][5] Evidence supporting the use of PoCUS in hypotension is limited to diagnostic improvements.…”

Section: Introductionmentioning

confidence: 99%

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International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest

Atkinson

Bowra

Milne

et al. 2016

CJEM

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This executive summary will provide a brief overview of consensus statements on sonography in hypotension and cardiac arrest (SHoC) recommended by the International Federation for Emergency Medicine (IFEM) for use in emergency medicine (EM). PurposeAs point of care ultrasound (PoCUS) has become an established tool in the initial management of patients with undifferentiated hypotension and during cardiac arrest, the Ultrasound Special Interest Group (USIG) of IFEM was tasked to provide consensus guidance for use in EM that was designed to be widely implementable internationally, and which was targeted at likely etiologies as well as guiding resuscitation. The protocols were also aimed at minimizing interruption of ongoing resuscitation. A hierarchical model was proposed, to be developed by expert consensus based upon disease incidence, previously published protocols, and the medical literature. A practical checklist was to be developed, along with a standardized approach to the performance of scans based upon a "4 F" approach: fluid, form, function, filling. Consensus approachWe summarized the recorded incidence of PoCUS findings from two international multicentre prospective studies

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Section: Introductionmentioning

confidence: 99%

“…Previously published algorithms fail to adopt a hierarchical approach to their various components, [1][2][3] and most recommend that every patient receives every view, every time. The aim of this consensus was to develop an approach that could be adapted to each clinical scenario.…”

Section: Introductionmentioning

confidence: 99%

International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest

Atkinson

Bowra

Milne

et al. 2016

CJEM

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“…Some protocols consisting in a goal-directed ultrasonography evaluation that integrate cardiac, abdominal and venous examination, have been already proposed and validated [7][8][9]. Some review articles already introduced the adjunct of a lung evaluation in the multi organ ultrasonography diagnostic procedure of undifferentiated hypotension and shock, but have not been validated by prospective studies on patients [10][11][12][13][14].…”

Section: Undifferentiated Hypotension Is a Common Condition In The Emmentioning

confidence: 99%

Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

et al. 2013

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“…On the contrary, the diagnosis of a dissection or of a broken aneurysm could be challenging and predicted only by the presence of indirect signs, such as a dilated aorta or the evidence of free fluid in the peritoneum. Nevertheless, when US is closely related to the patient's history and the clinical assessment, diagnostic accuracy can be extremely high [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…Many out-of-hospital algorithms have been successfully tested by providers [9], including the focused assessment of sonography for trauma (FAST) and the Extended-FAST [9,10], the focused echocardiography in life support (FEEL) protocol during cardiopulmonary resuscitation (CPR) [11], the lung ultrasound (LUS) for the evaluation of respiratory insufficiency [2,12] and the rapid ultrasound for shock and hypotension (RUSH) protocol for hemodynamic instability [13]. The study of the abdominal aorta in a patient with abdominal pain and hemodynamic instability could be another important indication of pre-hospital US [2,14].…”

Section: Introductionmentioning

confidence: 99%

Early identification of aortic dissection with pre-hospital ultrasound: a case report

Zanatta¹,

Scorpiniti²,

Cianci³

2018

EJMCR

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BackgroundPoint of care ultrasound (POCUS) is considered an important diagnostic tool in the Emergency Department.Current developments in technology, the presence of portable ultrasound (US) machines, the improvement of the quality and resolution of the images, have increased the performance of US also in the pre-hospital setting [1,2].Several studies have demonstrated the feasibility and accuracy of pre-hospital US, performed either by physicians or paramedics, in many pre-hospital scenarios including land ambulances and helicopters of the Emergency Medical Services [3][4][5][6].Pre-hospital emergency US should be even more focused, rapid, and problem based than in-hospital point of care US, to reduce morbidity and improve outcomes for patients with life-threatening conditions. The integration of focused US with clinical signs improves diagnostic accuracy and provides crucial information to guide the diagnosis, the therapy and to improve the field triage, in order to deliver the patients to the most appropriate destination [7,8].Many out-of-hospital algorithms have been successfully tested by providers [9], including the focused assessment of sonography for trauma (FAST) and the Extended-FAST [9,10], the focused echocardiography in life support (FEEL) protocol during cardiopulmonary resuscitation (CPR) [11], the lung ultrasound (LUS) for the evaluation of respiratory insufficiency [2,12] and the rapid ultrasound for shock and hypotension (RUSH) protocol for hemodynamic instability [13]. The study of the abdominal aorta in a patient with abdominal pain and hemodynamic instability could be another important indication of pre-hospital US [2,14].The evaluation of the aorta is fast, and the dilation of the artery can be easily identified. On the contrary, the diagnosis of a dissection or of a broken aneurysm could be challenging and predicted only by the presence of indirect signs, such as a dilated aorta or the evidence of free fluid in the peritoneum. Nevertheless, when US is closely related to the patient's history and the clinical assessment, diagnostic accuracy can be extremely high [12][13][14][15].This case report analyses the feasibility and usefulness of pre-hospital US for the evaluation of the aorta in a hemodynamically unstable patient. Case PresentationWe present a case of a 50-year-old man who suddenly lost consciousness while he was working. He remained unconscious for a few minutes and then recovered slowly. Early identification of aortic dissection with pre-hospital ultrasound: a case report ABSTRACTBackground: Several studies have demonstrated the feasibility of pre-hospital ultrasound (US) in patients with trauma, cardiac arrest, and respiratory insufficiency. It should be rapid, problem based and the use of specific protocols (focused assessment of sonography for trauma, focused echocardiography in life support, and rapid ultrasound for shock and hypotension) prevents delays.

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The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically lll

Cited by 538 publications

References 107 publications

International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest

International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest

Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

Early identification of aortic dissection with pre-hospital ultrasound: a case report

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