RUSH – Excelling at the Bedside

One of the areas that Emergency Medicine excels in is the rapid assessment of patients at the bedside, and as such it makes sense that we should be leaders in innovations that help bring this skill to its apogee. In an upcoming post I will talk about this more, but for now suffice it to say that it is one of the reasons I love ultrasound, and in particular the RUSH (Rapid Ultrasound for Shock and Hypotension) exam as an example of what we should be striving for.  I’ve just spent the afternoon reading:

The RUSH Exam 2012: Rapid Ultrasound in Shock in the Evaluation of the Critically Ill Patient, by Phillips Perera, MD, RDMS, Thomas Mailhot, MD, RDMSa, David Riley, MD, MS, RDMS, Diku Mandavia, MD, FRCPC  The RUSH Exam 2012.  The RUSH Exam 2012 (annotated version)

For those not familiar with RUSH, it is the FAST (Focused Assessment with Sonography for Trauma) exam, along with other familiar cardiovascular ultrasound techniques, to rapidly assess the patient in undifferentiated shock.  But this simple explanation belies its true genius: by applying concepts in physiology, with bedside clinical acumen within a structured collection of ultrasound imaging techniques, a powerful diagnostic tool emerges. I’m a big fan of this innovation, and hope we will see more of this creativity in the future of our specialty.

The above article is a bit long, so I’ve annotated and highlighted a copy of it to emphasize what I think are the most relevant parts for a practicing EM physician who already has decent ultrasound ability. I’m also bundling a few other resources on the topic so that you can really get familiar with the exam.  In my experience you have to reach a certain comfort level with a technique before it can become a part of your daily practice.  After that its smooth sailing.  ENJOY.

  • Sinai Emergency Medicine Ultrasound @http://sinaiem.us/   This site has a bunch of great tutorials on all the aspects of the exam.
  • I am not familiar with the detailed evolution of the RUSH exam in its current form, but Scott Weingart MD over at EMCrit.org has been a leader in this area for nearly a decade now and his site has a great overview as well as an audio lecture on the topic that is well worth listening to.
  • All LA Conference lecture on “Undifferentiated Hypotension” by Ravi Morchi MD.  This is a great lecture that pulls together all of the physiology concepts involved in the RUSH exam to bring it all home for you.

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