Overview of Diagnostic Ultrasound Use in Undifferentiated Hypotension
Hypotension, or low blood pressure, is a common issue that brings people to the emergency room. Sometimes, it can be hard for doctors to figure out what’s causing the low blood pressure just by asking questions and doing a physical exam. When the situation is critical, there might not be enough time to wait for lab tests or detailed imaging studies like MRI or CT scans.
Instead, doctors often turn to a quick test done at the bedside called an ultrasound to help them figure out what might be causing the low blood pressure. The ultrasound is quick, accurate and can be done right in the emergency room, helping doctors make decisions faster.
There are different ways to do the ultrasound exam for the patient with low blood pressure and one common method is called the RUSH protocol. The RUSH protocol is a targeted ultrasound exam that checks certain parts of the body. It uses a method called HI-MAP to remember what parts of the body to check: the heart, the inferior vena cava (the large vein that carries blood from the lower half of the body back to the heart), Morrison’s pouch (an area in the abdomen that might fill with fluid if there’s internal bleeding), the aorta (the large blood vessel that carries blood from the heart to the rest of the body), and the lungs.
The RUSH protocol is a systematic way of looking at the body to figure out what might be causing the low blood pressure, and some have simplified it even further to a “pump, tanks, pipes” approach. Remember, the aim for using this type of ultrasound exam is to help determine the cause of low blood pressure in the quickest way possible and allow prompt treatment.
How is Diagnostic Ultrasound Use in Undifferentiated Hypotension performed
The RUSH Exam is a test done by a medical professional to quickly and accurately assess a patient’s condition, especially their heart and blood vessels, using ultrasound. Here’s what your doctor might be looking for:
First, they would want to know how well your heart is pumping. They use the ultrasound to view your heart. From this view, your doctor can estimate how well your heart is functioning by looking at how much it moves and how it changes size with each beat. This helps them understand if your heart is working normally, or if there may be any issues. If your heart seems to be moving too much or too little, this could suggest certain health conditions that the doctor needs to look into.
Second, they would want to know if there’s any unusual strain or pressure on the right side of your heart, which could be a sign of a pulmonary embolus (a blood clot in an artery in your lungs). They assess this by comparing the sizes of the right and left heart chambers. Normally, the right chamber should be about 60% the size of the left heart chambers. If the right chamber is much bigger than usual, it might be due to a blood clot.
Lastly, they might look at whether there’s any liquid pooling around your heart, which we refer to as a clinically significant pericardial effusion. This could affect your heart’s ability to pump blood effectively. A small amount of fluid may not pose a significant risk however, a large accumulation could lead to serious complications.
In addition to the heart, the RUSH Exam also assesses the condition of the Inferior Vena Cava (a large vein carrying non-oxygenated blood from the lower half of the body to the heart). The doctor observes how this vein changes in size with your breathing. They might also take a look at Morrison’s Pouch, a space between your liver and kidney, to see if there’s any unusual fluid, which could be indicative of internal bleeding.
The ultrasound can also check the condition of the patient’s aorta – the main artery carrying oxygenated blood from the heart to the rest of the body. If the diameter of the aorta equals or exceeds 3 centimeters, it may be a sign of an abdominal aortic aneurysm – a serious health condition where the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward.
Lastly, the ultrasound can scan the lungs to check for potential issues like a pneumothorax (collapsed lung) and B-lines (vertical lines on the lung ultrasound, which might indicate fluid overload in the lungs).
In summary, the RUSH Exam is a comprehensive evaluation using ultrasound that allows the doctor to make a quick and accurate assessment of a patient’s status, and jump-start any necessary treatments.
What Else Should I Know About Diagnostic Ultrasound Use in Undifferentiated Hypotension?
The RUSH exam is a handy, tested medical tool that doctors can quickly use when a patient comes in to help figure out why they might be experiencing abnormally low blood pressure. There are many guides available that detail how to do this exam step by step- like choosing the appropriate device, the sequence of the examination, and making sense of the obtained images. This simplified review talks about the RUSH exam and how it can be used to pinpoint the different reasons a person might have dangerously low blood pressure. This can help your doctor provide immediate treatment that could potentially save your life.
