The impact of using RUSH protocol for diagnosing the type of unknown shock in the emergency department

Abstract

Clinical assessment and classification of shock is extremely difficult to conduct on critically ill patients especially upon arrival at the emergency department. Resuscitative point-of-care ultrasound could be used for rapid initial diagnosis and better management. In this study, the results of using the RUSH (Rapid Ultrasound in Shock) exam to determine the type of shock in the emergency department are compared to the final diagnosis of patients. This was a single-center prospective study in which all patients with an unknown type of shock and no prior treatment were included. Parallel to the standard resuscitative management and diagnosis of the emergency team, the RUSH exam was performed blindly on the patient by an emergency medicine staff who was not part of the patient's caregiving team. The results of the RUSH exam were then compared to the final diagnosis of the patients and the 48-h outcome. Twenty-five patients were enrolled in this study. The overall kappa correlation of the RUSH exam compared with the final diagnosis was 0.84 which is an almost perfect agreement. The overall sensitivity of the RUSH exam was 88 % and the specificity was 96 %. Although the mortality rate was 64 %, there was not a significant relationship between mortality and the protocol used for diagnosis. The RUSH exam could be used in emergency wards to detect types of shock.

SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department

“…The use of point of care ultrasound has positively influenced and speed up this process. Several problem-oriented focused bedside ultrasound scanning protocols have been proposed in the field of critical care and emergency medicine [1, 2, 10, 13, 14, 16, 19, 20]. Lichtenstein and Meziere [1] describe the BLUE protocol for patients with acute respiratory failure.…”

“…Using information from lung and IVC ultrasound, physician can embark on a treatment plan, and be guided subsequently by cardiac ultrasound [21]. Most ultrasound guided resuscitation protocols are designed to evaluate patients with hypotension or dyspnea using basic cardiovascular and lung ultrasound findings [1, 2, 10, 13, 14, 16, 19, 20]. As many acute care providers have gained the required competency, it is opportune to explore the expansion of the armamentarium that point of care ultrasound can provide.…”

“…(3) While the disease profiles of the 308 patients reflect the frequency of diseases encountered, the numbers for certain specific diseases, such as pericardial effusion, are small. Although it has been shown that an integrated ultrasound produced a high degree of accuracy in making a diagnosis of specific disease entities [1, 10, 13], the utility of SEARCH 8Es in this area could be further researched in larger-scale studies. (4) As the physician performing the initial clinical evaluation and subsequent SEARCH 8Es are the same person, the prior clinical impression could have influenced the way sonographic findings are interpreted.…”

“…Kaysville, Utah, USA). The null hypothesis correlation of 0.76 and the alternative hypothesis correlation of 0.83 were chosen by prior study [10]. Therefore, the total number of 308 patients enrolled in the current study was sufficient to achieve the power of this current study.…”

A Patient on Airway Pressure Release Ventilation With Sudden Hemodynamic Collapse

“…The usefulness of goal-directed POCUS in diagnosing cause of shock and guiding subsequent treatment in a patient with undifferentiated shock is well described in both the critical care and emergency medicine literature. 1 While different POCUS protocols differ in sequence of POCUS examinations, the commonalities include examining four standard bedside cardiac ultrasound views including parasternal long axis, parasternal short axis, apical four chamber, and subcostal four chamber. 1 However, given the unique limitations of critically ill patients such as body habitus and urgency of the clinical condition, the American Society of Echocardiography recognizes that in such instances, clinical decisions have to be made on the basis of limited POCUS views.…”