UMEM Educational Pearls

  • The RUSH exam is a rapid way to identify the cause of shock using ultrasound. What's the RUSH exam? Click here
  • The RUSH exam does not include an assessment of volume responsiveness (VR), but a new article by Blaivas, Aguiar, and Blanco suggests that it should be.
  • VR has classically been assessed by determining the stroke volume before and after a passive leg raise or a fluid bolus. Click here for a video on how to calculate the stroke volume (skip to 21:30 in the video)
  • The authors claim that VR can further be simplified by not measuring the left ventricular outflow tract (LVOT) and only comparing changes in the velocity-time integral (VTI). The assumption is that the LVOT is constant and doesn't change in most circumstances; a change of VTI that is greater than 15% suggests that the patient is VR
  • Further validation is required to determine the degree of benefit to adding VTI to the RUSH exam, however measuring VTI is a skill that can be done with relatively little training and is clinically helpful.