RUSH: Rapid Ultrasound in SHock in the evaluation of the critically ill Flashcards Preview

Faith's Multisystems module > RUSH: Rapid Ultrasound in SHock in the evaluation of the critically ill > Flashcards

Flashcards in RUSH: Rapid Ultrasound in SHock in the evaluation of the critically ill Deck (14)
Loading flashcards...
1
Q

What are the three things evaluated in RUSH?

A

PUMP
TANK
PIPES

2
Q

What is evaluated in the PUMP of RUSH?

A

The Heart-
Parasternal views (long (point to right shoulder) and short (point to left shoulder) axis)
subxiphoid view
apical view (roll patient on left, put on point of max impulse)

3
Q

What is evaluated in the TANK of RUSH?

A
IVC (long acid)
eFAST (RUQ)
eFAST (LUQ)
FAST (pelvis)
Pulmonary - for pneumothorax
4
Q

What is evaluated in the PIPES of RUSH?

A

Thoracic aorta
AAA
Femoral DVT
Popliteal DVT

5
Q

Which probes do you usually use in RUSH?

A
Phased array (good for getting between the ribs)
Curved linear (good for prettier picture- more crystals)
6
Q

What is the difference between the cardiac preset and the abdominal preset?

A

Cardiac preset: marker is on the left - point probe to the left of patient.
Abdominal preset: marker is on the right - point probe to the right of patient

7
Q

For the PUMP: What are the key physical findings you are looking for?

A

Look at the contractility (increased, decreased, nl?)
- ejection fraction (look at mitral valve slapping septum)
Looks for pericardial effuse/tamponade
Look for RV strain (enlarged RV?) look to see if any part of the wall of the heart is not moving?

8
Q

Pericardial effusion vs. pleural effusion

A

if fluid goes between heart and descending aorta (look for rat tail), it is pericardial effusion. No rat tail = pleural effusion.

9
Q

What are the finding of a pulmonary embolism?

A

see clot moving around in right ventricle (clothes in a washing machine. Dilated right ventricle (blood can’t flow out of right ventricle). R ventricle is typically 60% in size of L ventricle normally. D SHAPED SEPTUM: right ventricle pushing into Left ventricle. Also IVC should be large (backed up)

10
Q

How do you tell the difference between a bad asthma patient and a PE?

A

Bad asthma would have chronic pulmonary hypertension = will have a thick right ventricle wall. PE will have a large R ventricle with a thin wall.

11
Q

How do you tell right ventricle from left ventricle?

A

right ventricle has a moderator band: a white line that almost cuts the right ventricle in half

12
Q

For the TANK: What are the key physical findings you are looking for?

A

IVC size/respiratory dynamics
- small and collapses = hypovolemic
- large and does not collapse
eFAST exam: free intraperitoneal fluid, pleural effusio/hemothorax
pulmonary: pneumothorax, ultrasonic B lines.

13
Q

what is a mirror image artifact?

A

if you hit a bright reflective structure with air on one side - will see a mirror image on other side of diaphragm (sign lung is full of air). No mirror image = no air there - probably fluid.

14
Q

Tension pneumothorax: which probe do you use? where should it be located if it is positive? How do you check? positive findings of pneumothorax?

A

IVC kinked off. Use linear high frequency array. Air rises - pneumothorax should be at the top of the lungs. check entire side: from top to bottom. On left side go a bit to the side to avoid the heart.

positive findings = no sliding seen when breathing in. Use M mode (motion mode). Normal = see a sandy sea shore. Positive finding = bar code sign/stratesphere sign.