EM Vivas · POCUS — aortic, lung & cardiac
RUSH protocol viva — pump, tank, pipes
Clinical viva on RUSH synthesis and key sonographic discriminators.
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Target exams
ACEMFRCEMABEM
Prompt
Undifferentiated shock in a 68-year-old. Walk through RUSH. How do you measure the aorta? How do you distinguish massive PE from cardiogenic oedema sonographically?
Interpretation
Reveal interpretationShowHide
I structure the exam as pump (heart), tank (IVC/lungs/FAST), pipes (aorta/vessels) and synthesise a shock profile.[1] Aorta: complete sweep with transverse cuts; measure per local aortic protocol. PE vs oedema: combine lung patterns (A lines versus interstitial B-line patterns) with cardiac and venous findings (BLUE-style profiles reached the correct diagnosis in 90.5% of respiratory-failure cases).[5] Ruptured AAA with shock goes per local vascular-surgery pathway, not CT first — confirm locally.
References3ShowHide
- [1]Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin N Am, 2010.PMID 19945597
- [5]Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest, 2008.PMID 18403664
- [4]Lichtenstein D, Mezière G, Biderman P, Gepner A. The "lung point": an ultrasound sign specific to pneumothorax. Intensive Care Med, 2000.PMID 11126253