Madtown Sono

The RUSH Exam (ACB)

Objectives

  1. Know the individual components of the RUSH Exam
  2. Understand the goals of the focused cardiac exam in RUSH: LV function, RV size, pericardial effusion
  3. Name disease states which would case a non-collapsible (fat) IVC vs. collapsible (flat) IVC
  4. Recognize the appearance of abdominal free fluid on ultrasound; name potential causes of abdominal free fluid.
  5. Know the components of an aorta assessment and normal diameter of the aorta in the short-axis view
  6. Identify the presence of normal lung sliding in contrast to the absence of lung sliding via M-mode

 

Lecture (presented by Hani Kuttab, MD)

For instructors:

ACB: The Rush Exam– Putting it all together: Clinical Cases

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Name the five components of the RUSH Exam.

Remember the mnemonic ‘HI-MAP’:

  1. Heart
  2. IVC
  3. Morison’s
  4. Aorta
  5. Pulmonary

What are the three goals of the cardiac exam when performing a RUSH ultrasound?

The three goals:

  1. Evaluate for left ventricular function: normal or reduced.
  2. Evaluate for right ventricular enlargement: normal or enlarged.
  3. Evaluate for pericardial effusion. If present, is there RV collapse concerning for tamponade?

Name disease states that could give you an enlarged (fat) IVC versus a collapsed (flat) IVC?

Fat IVC

Cardiac tamponade, volume overload (heart failure), massive pulmonary embolism

Flat IVC

sepsis, hypovolemic shock

What is the typical appearance of free fluid in the abdomen, and where is it most likely to accumulate?

Abdominal free fluid appears anechoic on ultrasound. The inferior tip of the liver (in the RUQ) is the most sensitive area to detect abdominal free fluid.

Name three potential causes of free fluid in the abdomen.

Three Causes:

  1. Physiologic (e.g., normal), consider this in pediatric patients vs. menstruating females
  2. Ascites, consider this in patients with cirrhosis, heart failure, or end-stage renal disease
  3. Hemorrhage, consider this in patients with abdominal trauma

Where are abdominal aortic aneurysms most likely to occur?

Most abdominal aortic aneurysms are located in the mid-aorta, beneath the renal arteries (ie., infrarenal).

What is the normal diameter of the aorta, in the short axis view, when measured from anterior to posterior?

Normal is <3cm (remember, three A’s in AAA, so <3cm is normal)

Aortas >5cm are concerning any may need surgical consultation

What is the typical 'M-mode' finding of lung sliding on lung ultrasound? What about pneumothorax?

The normal appearance of lung on M-mode is the ‘sandy beach sign’, which is the parietal and visceral pleura sliding over one another.

Lack of lung sliding on M-mode is the ‘bar-code sign’, which is just visualization of the parietal pleura (without anything to slide against).