Clinics in Medical Education

RUSH Ultrasound

Module 1: Introduction to RUSH / FAST

This module focuses on conceptual framework of the “Pump, Tank, and Pipes” and will explore key ultrasound views used to identify the type and cause of shock. The module consists of two instructional videos:

  1. Introduction to Shock and the RUSH Protocol
  2. RUSH Protocol: Components and Ultrasound Views

Learning Objectives

By the end of this module, learners will be able to:

  1. Describe the clinical indications for using the RUSH protocol in shock evaluation.
  2. Understand and apply the “Pump, Tank, and Pipes” framework for structured bedside assessment.
  3. Identify and interpret the ultrasound views relevant to each component of the RUSH exam:
    • Pump: Parasternal, subxiphoid, and apical cardiac views
    • Tank: IVC, FAST (right upper quadrant, left upper quadrant, pelvis)
    • Pipes: Aorta, lung (anterior, lateral), femoral vein
  4. Identify the four standard FAST exam views:
    • Right upper quadrant (Morrison’s pouch)
    • Left upper quadrant (splenorenal space)
    • Pelvis (pouch of Douglas/rectovesical space)
    • Pericardial view (subxiphoid or parasternal)
  5. Recognize key ultrasound findings associated with the four main types of shock:
    • Hypovolemic shock
    • Cardiogenic shock
    • Obstructive shock
    • Distributive shock
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Introduction

Protocol

Module 2: Evaluation and Pathologies

 

This module includes an overview of the structured approach (Pump, Tank, Pipes) and demonstrates the use of ultrasound to evaluate each component. Learners will also review the ultrasound findings associated with key types of shock and learn to compare pathologies. The module includes two instructional videos:

  1. Evaluation of RUSH Components: Pump, Tank, and Pipes
  2. Shock Pathologies and Ultrasound Comparison

Learning Objectives

By the end of this module, learners will be able to:

  1. Perform a systematic ultrasound exam targeting the three RUSH components:
    • Pump: Evaluate for pericardial effusion, global cardiac function, and right heart strain.
    • Tank: Assess volume status using IVC, and scan for free fluid with abdominal FAST views.
    • Pipes: Evaluate for aortic aneurysm/dissection, deep vein thrombosis, and pneumothorax.
  2. Recognize and differentiate key ultrasound findings associated with major types of shock:
    • Hypovolemic shock: Small IVC, hyperdynamic heart, absence of free fluid or effusion.
    • Cardiogenic shock: Poor left ventricular function, possible pulmonary edema.
    • Obstructive shock:
      • Tamponade: Pericardial effusion with RV diastolic collapse.
      • PE: Dilated RV, McConnell’s sign.
      • Tension pneumothorax: Absent lung sliding, barcode sign.
    • Distributive shock: Hyperdynamic heart, flat IVC, no obstructive or hypovolemic signs.
  3. Compare the sonographic patterns of each shock type across multiple systems to aid diagnosis and guide early treatment.
  4. Integrate findings from cardiac, respiratory, and abdominal ultrasound views to create a complete clinical picture in patients with hypotension or shock.

Evaluation and Pathologies

Comparing Pathologies

RUSH Ultrasound Cases

Module 3: Cases

This module builds on foundational knowledge of the RUSH protocol by applying it to clinical scenarios. Learners will engage with case-based examples that integrate the “Pump, Tank, and Pipes” approach and demonstrate how point-of-care ultrasound (POCUS) findings influence diagnosis and management of shock. Two case-based videos are included:

  1. Core Cases
  2. Advanced Cases

Learning Objectives

By the end of this module, learners will be able to:

  1. Apply the RUSH protocol in clinical scenarios to assess and diagnose the cause of shock.

  2. Interpret ultrasound findings in real-time across multiple views (cardiac, lung, abdominal) during case presentations.

  3. Differentiate shock etiologies based on dynamic sonographic findings and clinical context:

    • Identify signs of tamponade, tension pneumothorax, right heart strain, hypovolemia, and pump failure.

  4. Recognize subtle and complex presentations of shock in advanced cases (e.g., mixed shock states, delayed tamponade, distributive shock with atypical findings).

  5. Prioritize diagnostic and therapeutic decisions based on ultrasound results in time-sensitive emergency settings.

  6. Reflect on pitfalls and limitations of POCUS in challenging cases and how to address diagnostic uncertainty.

Cases and Review Questions

Advanced Cases

Module 4: FAST Only Cases

This module provides a case-based approach to mastering the Focused Assessment with Sonography in Trauma (FAST) exam. Learners will apply the FAST protocol across a range of clinical trauma scenarios to identify free fluid in peritoneal, pelvic, and pericardial spaces. Through both core and advanced cases, learners will enhance their interpretation skills and understand how FAST findings guide emergent management. The module includes two case-based videos:

  1. FAST Cases: 1-10
  2. FAST Cases: 11-20

Learning Objectives

By the end of this module, learners will be able to:

  1. Perform and interpret the four key FAST exam views:
    • Right upper quadrant (RUQ/Morrison’s pouch)
    • Left upper quadrant (LUQ/splenorenal space)
    • Pelvis (pouch of Douglas or rectovesical pouch)
    • Pericardial (subxiphoid or parasternal)
  2. Identify sonographic signs of free fluid suggestive of hemoperitoneum, hemopericardium, or hemothorax.
  3. Correlate the mechanism of injury with expected sonographic findings in blunt and penetrating trauma.
  4. Use FAST exam findings to make time-critical decisions in unstable trauma patients.

FAST Cases 1-10

FAST Cases 11-20