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Rule of RUSH protocol in management of shocked patients

Volume 6, Issue 6, December 2021    |    PP. 652-673    |PDF (606 K)|    Pub. Date: November 23, 2021
DOI: 10.54647/cm32583    7 Downloads     92 Views  

Author(s)
Hamdy A. Mohammadien, Departments of Chest Diseases, Sohag Faculty of Medicine, Sohag University, Egypt
Gamal M. Agamy, Assuit Faculty of Medicine, Assuit University, Egypt
Esrra F. Ahmad, Departments of Chest Diseases, Sohag Faculty of Medicine, Sohag University, Egypt
Azza M. Ahmad, Departments of Chest Diseases, Sohag Faculty of Medicine, Sohag University, Egypt

Abstract
Background: Clinical assessment and classification of shock is extremely difficult to conduct on critically ill patients. Rapid Ultrasound in Shock (RUSH) is an easily learned and quickly performed shock ultrasound protocol, it allows for rapid evaluation of reversible causes of shock and improves accurate diagnosis in undifferentiated hypotension.
Objectives: to evaluate the accuracy of early RUSH protocol performed by chest physicians to predict type of shock and its guide of resuscitation in critically ill patients. Patients and Methods: Study was conducted on 68 patients with shock state in Respiratory Intensive Care Unit (RICU) of Chest Department at Assuit University Hospital and evaluated for the cause of shock by performing early RUSH protocol for patients. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index. Sensitivity, Specificity, positive predictive value (PPV) and negative predictive value (NPV) of RUSH for diagnosis of each case.
Results: We performed RUSH examination on 68 shocked patients. 39 were males (58%) and 29 were females (41%), with mean age 58 years. Kappa index was 0.85 (P= 0.0001), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97%, but it had low sensitivity. For shock with distributive or mixed etiology, RUSH showed a PPV of {97% & 100%} respectively, with high sensitivity. The agreement of protocol for final diagnosis was highest in distributive and obstructive shock followed by cardiogenic and hypovolemic shock [(94% & 93%), P < 0.001 & (84% & 73%), P < 0.001,] respectively. There was a statistically significant relationship between IVCe, IVCi & IVC index and different types of shock (P < 0.0001).Also There was a statistically significance relationship between CVP and different types of shock (P= 0.0001). There was a statistically significance correlation between CVP and IVC index (P < 0.0001), IVCe diameter (P < 0.0001), and IVCi diameter (P < 0.0002).
Conclusion: We highlight the role of integrating focused ultrasound techniques, such as the RUSH examination, in the physician resuscitation pathways to diagnose shock etiology, augment their clinical evaluation and guide resuscitation.
Clinical Implications: Early identification of causes of shock in critically ill patients allow good clinical evaluation and guide resuscitation and help physician to used correct treatment.

Keywords
cardiogenic shock, hypovolemic shock, obstructive shock, rapid ultrasound in shock, RUSH exam., Shock

Cite this paper
Hamdy A. Mohammadien, Gamal M. Agamy, Esrra F. Ahmad, Azza M. Ahmad, Rule of RUSH protocol in management of shocked patients, SCIREA Journal of Clinical Medicine. Vol. 6 , No. 6 , 2021 , pp. 652 - 673 . https://doi.org/10.54647/cm32583

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