Episode 6: RUSH Part 3 - The Tank

by Bob Stuntz in

You get it by now.  You're taking care of a crashing patient.  Finish up your RUSH exam by making sure the tank is full.  The final episode of the 3 part RUSH series.

Episode 6: RUSH Part 3: The Tank (Tom Kehrl, MD, RDMS)

  • IVC
    • Phased array probe or curvilinear probe, just to the right of midline subxyphoid area
    • Look 2 cm caudal to the hepatic vein inlet
    • Look for collapse (or lack thereof) with sniffing (Use M mode)
    • Caval index: look for collapse of the IVC and measure after sniff (inspiration).  GENERALLY:
      • > 50% collapse: CVP < 10
      • < 50 % collapse: CVP > 10
      • This is helpful only in extremes (i.e. very dry or very volume overloaded).  Take this with a grain of salt. 
  • FAST exam: Looking for free fluid in the abdomen
  • Pneumothorax: Linear high frequency probe , saggital view, above and below ribs in view (batwing appearance).  Look for lung sliding
    • Comet tail artifact: reverb artifact starts at the pleura, tells you there is no PTX
    • Color doppler
      • Normal = color below the pleural line 
      • PTX = no color below the pleural line
    • M Mode: Icepick looking at motion toward and away from the probe plotted over time.  Place across pleural line in between two ribspaces
      • Normal = seashore sign
      • PTX = stratosphere sign.  
    • Again, can be false positive (transtracheal jet insufflation, apnea, pleural scarring/masses, mainstem intubation)
    • US shown to have sensitivity/specificity >90%
    • Lung point: Point where lung sliding meets PTX.  100% specific for PTX
      • Can be used to size PTX
  • B lines: Start at the pleural line and shoot all the way down to the bottom of the screen.  Make sure harmonics is off as lung US is based on artifacts and tissue harmonics make for less of those. 
    • > 3 per interspace at multiple interspaces suggestive of pulmonary edema
  • Pleural effusion: can be used to diagnose empyema, hemothorax, simple effusion

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