Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol

Dina Seif, Phillips Perera, Thomas Mailhot, David Riley, Diku Mandavia, Dina Seif, Phillips Perera, Thomas Mailhot, David Riley, Diku Mandavia

Abstract

Assessment of hemodynamic status in a shock state remains a challenging issue in Emergency Medicine and Critical Care. As the use of invasive hemodynamic monitoring declines, bedside-focused ultrasound has become a valuable tool in the evaluation and management of patients in shock. No longer a means to simply evaluate organ anatomy, ultrasound has expanded to become a rapid and noninvasive method for the assessment of patient physiology. Clinicians caring for critical patients should strongly consider integrating ultrasound into their resuscitation pathways.

Figures

Figure 1
Figure 1
The RUSH exam. Step 1: Evaluation of “the pump”.
Figure 2
Figure 2
Types of pericardial effusions, subxiphoid cardiac view. Left image: typical effusion, right image: clotted effusion. RV: right ventricle, LV: left ventricle, PE: pericardial effusion.
Figure 3
Figure 3
Pericardial effusion, parasternal long axis view. RV: right ventricle, LV: left ventricle, LA: left atrium.
Figure 4
Figure 4
Pleural effusion, parasternal long axis view RV: right ventricle, LV: left ventricle, LA: left atrium.
Figure 5
Figure 5
Cardiac tamponade, subxiphoid view. RV: right ventricle, RV: right atrium, LV: left ventricle, LA: left atrium, PE: pericardial effusion.
Figure 6
Figure 6
Good left ventricular contractility, parasternal long axis view. RV: right ventricle, LV: left ventricle, LA: left atrium.
Figure 7
Figure 7
Poor left ventricular contractility, parasternal long axis view. RV: right ventricle, LV: left ventricle, LA: left atrium.
Figure 8
Figure 8
M-mode tracing demonstrating excellent contractility. RV: right ventricle, LV: left ventricle.
Figure 9
Figure 9
M-mode tracing demonstrating poor contractility. LV: left ventricle.
Figure 10
Figure 10
E-point septal separation with decreased contractility. M-mode Doppler tracing. RV: right ventricle, LV: left ventricle.
Figure 11
Figure 11
Right ventricular dilation, parasternal long axis view. RV: right ventricle, LA: left atrium, LV: left ventricle, LVOT: left ventricle outflow tract.
Figure 12
Figure 12
The RUSH exam. Step 2: Evaluation of “the tank”.
Figure 13
Figure 13
Collapsible inferior vena cava, long axis view.
Figure 14
Figure 14
Inferior vena cava plethora, long axis view.
Figure 15
Figure 15
Small, collapsing internal jugular vein, short axis view. IJ: internal jugular vein, CA: carotid artery.
Figure 16
Figure 16
Large, distended internal jugular vein, short axis view. IJ: internal jugular vein, CA: carotid artery.
Figure 17
Figure 17
FAST exam.
Figure 18
Figure 18
Pleural effusion.
Figure 19
Figure 19
Pulmonary edema B-lines.
Figure 20
Figure 20
Normal lung.
Figure 21
Figure 21
Pneumothorax.
Figure 22
Figure 22
M-mode of normal lung versus pneumothorax.
Figure 23
Figure 23
The RUSH exam. Step 3: Evaluation of “the pipes”.
Figure 24
Figure 24
Abdominal aortic aneurysm (AAA) types.
Figure 25
Figure 25
Abdominal aortic aneurysm (AAA) measured, short axis view.
Figure 26
Figure 26
Aortic arch dissection with widened aortic root, parasternal long axis view. RV: right ventricle, LV: left ventricle, LA: left atrium, AV: aortic valve.
Figure 27
Figure 27
Limited leg deep venous thrombosis exam (starred veins).
Figure 28
Figure 28
Deep venous thrombosis of the femoral vein, short axis view.

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