The RUSH Exam 2012: Rapid Ultrasound in Shock in the Evaluation of the Critically Ill Patient

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

doi:10.1016/j.cult.2011.12.010

Cited by 144 publications

(199 citation statements)

References 154 publications

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“…1 Overall cardiac function is important in making more accurate diagnoses and clinical care decisions. [1][2][3][4][5][6] Visual estimates of LV systolic function can differentiate severely depressed from normal LV systolic function, but physicians often encounter disagreements in differentiating moderately depressed and normal LV systolic function. [7][8][9] Quantitative comprehensive echocardiographic measAnthony J. Weekes, MD, Abhiram Reddy, MD, Margaret R. Lewis, MD, H. James Norton, PhD Received April 19, 2012, …”

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confidence: 99%

E-Point Septal Separation Compared to Fractional Shortening Measurements of Systolic Function in Emergency Department Patients

Weekes

Reddy

Lewis

et al. 2012

Journal of Ultrasound in Medicine

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Prospective Randomized Study edside emergency cardiac sonography is ideally suited to rule in or rule out poor left ventricular (LV) systolic function. 1 Overall cardiac function is important in making more accurate diagnoses and clinical care decisions. [1][2][3][4][5][6] Visual estimates of LV systolic function can differentiate severely depressed from normal LV systolic function, but physicians often encounter disagreements in differentiating moderately depressed and normal LV systolic function. [7][8][9] Quantitative comprehensive echocardiographic measAnthony J. Weekes, MD, Abhiram Reddy, MD, Margaret R. Lewis, MD, H. James Norton, PhD Received April 19, 2012, ORIGINAL RESEARCHObjectives-Rapid bedside assessment of left ventricular (LV) function can aid in the evaluation of the critically ill patient and guide clinical management. Our primary hypothesis was that mitral valve E-point septal separation measurements would correlate with contemporaneous fractional shortening measurements of LV systolic function when performed by emergency physicians. Our secondary hypothesis was that E-point septal separation as a continuous variable would predict fractional shortening using a linear regression model.Methods-We studied a prospective convenience sample of patients undergoing a sequence of LV systolic function measurements during a 3-month period at a suburban academic emergency department with a census of 114,000 patients. The sample included adult emergency department patients who were determined by the treating emergency physician to have 1 or more clinical indications for bedside LV systolic function assessment. Investigators performed bedside M-mode cardiac sonographic measurements of fractional shortening and E-point septal separation using the parasternal long-axis window. The sequence of LV systolic function measurements was randomized.Results-A total of 103 patients were enrolled. The Pearson correlation coefficient for E-point septal separation and fractional shortening measurements was -0.59 (P < .0001). Linear regression analysis performed for E-point septal separation with fractional shortening as the dependent variable yielded an R 2 value of 0.35.Conclusions-E-point septal separation and fractional shortening measurements had a moderate negative correlation. E-point septal separation, when used as a continuous variable in a linear regression model, did not reliably predict fractional shortening.

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confidence: 99%

E-Point Septal Separation Compared to Fractional Shortening Measurements of Systolic Function in Emergency Department Patients

Weekes

Reddy

Lewis

et al. 2012

Journal of Ultrasound in Medicine

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“…A hagyományosnak mondható diagnosztika a betegek ellátása során zavartalanul folyt. Az alkalmazott 3 lépcsős RUSH-protokollt, amely viszonylag könnyen megtanulható és gyorsan kivitelezhető, Perera és mtsai 2010-ben közölték, majd bővítették [10,11]. Ennek során a keringési rendszert egy fűtési rendszerhez hasonlították, amely 3 fő részből áll: 1. a szív ("the pump"); 2. folyadéktartalom, effektív keringő vérvolumen ("the tank"); 3. erek ("the pipes").…”

Section: Módszerunclassified

“…A sokkos állapot hátterében álló kórélettani folyamatok körét a fentiek alapján sikerült leszűkíteni, a célzott lépések valamelyike (sokszor több is) patológiás eltérést mutatott (5. táblázat) [11].…”

Section: Eredeti Közleményunclassified

“…A kritikus ellátásban hangsúlyozandó a komplex, klinikai szemléletet igénylő tünetorientált (symptome-based vagy problem-based) modulok ismerete. Ilyen például a sokkos állapotra kifejlesztett protokollok közül a RUSH (Rapid Ultrasound in Shock) [10,11], de léteznek a légzési elégtelenség gyors differenciál-diagnosztikáját célzó alkalmazások is [12,13]. A robbanásszerű terjedésben kulcsszerepe volt a hordozható, jó minőségű és költséghatékony UH-készülékek megjelenésének.…”

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Az ágy melletti ultrahangvizsgálat diagnosztikus lehetőségeinek vizsgálata a sürgősségi betegellátásban

2016

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Bevezetés: Az ismeretlen etiológiájú kritikus állapotok közül a keringési elégtelenség (sokk) gyors differenciáldiag-nosztikája mindennapi kihívás a sürgősségi betegellátásban. A "Rapid Ultrasound in Shock" (RUSH) protokoll 2010 óta ismert, amelynek segítségével a négy sokkforma (kardiogén, disztributív, obstruktív, hypovolaemiás) elkülöníthe-tő. A módszerrel percek alatt megállapítható, hogy a háttérben milyen kórfolyamat (pericardialis tamponád, szívelég-telenség, tüdőembólia, hypovolaemia, vérzés, feszülő légmell, aortadissectio, illetve aortaaneurysma-ruptura vagy disztributív sokk) áll. Célkitűzés: A szerzők a RUSH protokoll alkalmasságát vizsgálták a sokk differenciáldiagnoszti-kájában. Módszer: A retrospektív vizsgálatban 123 kritikus állapotú beteg vizsgálatának eredményeit elemezték. A betegeket a Markusovszky Kórház Sürgősségi Osztályán egy klinikai, tünetorientált ultrahangmodul segítségével vizsgálták. A betegekről részletes feljegyzéseket és képanyagot rögzítettek. Eredmények: A vizsgált betegek közül 64 beteg szenvedett sokkban, a többi kritikus állapotú beteg akut, súlyos mellkasi vagy hasi fájdalomban, illetve fulladás-ban szenvedett. Következtetések: Az eredmények megerősítik a célzott ágy melletti ultrahangvizsgálat előnyeit. Az első hazai vizsgálat eredményei alapján a szerzők véleménye szerint a módszer a hazai sürgősségi oktatásba és ellátásba integrálható. Orv. Hetil., 2016, 157(15), 569-574.Kulcsszavak: sürgősségi betegellátás, ágy melletti ultrahang, point of care ultrahang, keringési elégtelenség, RUSHprotokoll Evaluation of the diagnostic value of bedside ultrasonography in the critical careIntroduction: Rapid differential diagnosis of circulatory failure (shock) with unknown etiology is a daily challenge in the field of emergency medicine. The Rapid Ultrasound in Shock (RUSH) protocol is well known since 2010. With the use of targeted steps, the 4 forms of shock (cardiogen, distributive, obstructive, hypovolemic) can be separated in a few minutes. Aim: The aim of the authors was to evaluate the usefulness of the Rapid Ultrasound in Shock protocol for the diagnosis of different forms of shock. Method: The retrospective study included 123 critically ill patients admitted to the Emergency Department of Markusovszky Hospital, Szombathely, Hungary. Detailed records were obtained from all patients. Results: From the 123 crirically ill patients, 64 patients suffered from circulatory failure, while the remaining patients had acute severe chest or abdominal pain, or respiratory failure. Conclusions: Based on the results of the first evaluation of the Rapid Ultrasound in Shock protocol in Hungarian patients, the authors conclude that, the bedside ultrasonography has a great value in emergency medicine, and this the protocol is suitable for its integration into patient care and education of emergency medicine.

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“…8 While assessing the pump, intensivist looks for the presence of pericardial effusion (Fig. 1) and cardiac tamponade, which may be compressing the heart and leading to obstructive shock.…”

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Point-of-care Ultrasonography in Critically Ill Patients

2015

Kathmandu Univ. Med. J.

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Point-of-care ultrasonography has been used frequently by the physicians involved in managing critically ill patients. It allows direct visualization of pathology or abnormal physiological state at the bed side. The examination may be safely and effectively repeated as needed to follow the evolution of illness and the response to therapy. It is helpful to guide the therapy in patients with undifferentiated shock and for bedside diagnosis of common pathological conditions in acute care setting. It can facilitate common bedside procedures and interventions.

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The RUSH Exam 2012: Rapid Ultrasound in Shock in the Evaluation of the Critically Ill Patient

Cited by 144 publications

References 154 publications

E-Point Septal Separation Compared to Fractional Shortening Measurements of Systolic Function in Emergency Department Patients

E-Point Septal Separation Compared to Fractional Shortening Measurements of Systolic Function in Emergency Department Patients

Az ágy melletti ultrahangvizsgálat diagnosztikus lehetőségeinek vizsgálata a sürgősségi betegellátásban

Point-of-care Ultrasonography in Critically Ill Patients

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