Diagnostic Ultrasound Use in Undifferentiated Hypotension

Excerpt

Hypotension is a common presentation in the emergency department. At times, the available history is limited, and the physical exam alone may be misleading. In these life-threatening situations, waiting for laboratory studies or formal imaging studies may not be feasible. Instead, using bedside ultrasound can quickly narrow the potential etiologies of the hypotension. Multiple ultrasound protocols have been proposed for the evaluation of the hypotensive patient. The commonly-used rapid ultrasound in shock (RUSH) exam will be reviewed here. This bedside protocol has been demonstrated to quickly and accurately determine the etiology of shock in the hands of an emergency medicine physician.

The HI-MAP mnemonic describes the components of the RUSH protocol: heart, inferior vena cava (IVC), Morrison’s pouch (focused assessment with sonography for trauma [FAST] views with thoracic windows), aorta, pulmonary. This allows for a systematic approach to the exam. Others have also simplified the exam into the “pump, tanks, pipes” approach.