Table 2.

Rapid Ultrasound in SHock (RUSH) protocol summary for diagnosing four major types of shock

RUSH exam steps	Hypovolemic shock	Cardiogenic shock	Obstructive shock	Distributive shock
Step 1: Pump - Cardiac status (LV function, RV function, pericardium)	Preserved LVEF	Reduced LVEF, dilated LV, regional wall motion abnormalities	Pericardial effusion, RV strain	LVEF may be reduced in advanced septic shock
Step 2: Tank - Effective intravascular volume (IVC, lung scan, pleural or peritoneal fluid)	Small and collapsible IVC, no “B” lines on lung scan (no pulmonary edema)	Distended IVC, “B” lines present (pulmonary edema), pleural effusion, or ascites	Distended IVC, no lung sliding (pneumothorax)	Normal or small IVC, pleural effusion, or ascites may suggest a source of sepsis
Step 3: Pipes - Large vessels (thoracic and abdominal aorta, femoral and popliteal veins)	Aortic aneurysm and dissection	-	Deep venous thrombosis (source of pulmonary embolism)	-

IVC: Inferior vena cava, LV: Left ventricle, LVEF: Left ventricular ejection fraction, RUSH: Rapid Ultrasound in SHock, RV: Right ventricle