EMCrit 429 – RUSH 2.0 – The I-RUSH and CRUSH Exams
Consider integrating the iRUSH framework into your routine assessment of undifferentiated shock patients, even if they are currently stable. The tiered approach—using CRUSH for instability and I-RUSH otherwise—provides a systematic way to map hemodynamic derangements beyond simple blood pressure readings. Remember that this is a structured tool for phenotyping; always correlate the ultrasound findings with the patient's overall clinical picture.
This update introduces RUSH 2.0, or the iRUSH exam, which significantly expands upon the original rapid assessment tool for hemodynamic evaluation. The core concept is providing a standardized framework to systematically phenotype shock using readily available ultrasound modalities, moving beyond just assessing patients who are actively crashing. Two protocols are detailed: a highly abbreviated CRUSH exam designed specifically for the unstable patient, and a more comprehensive I-RUSH exam suitable for those not in immediate circulatory collapse. Essentially, it offers a structured approach to synthesizing clinical signs with advanced bedside ultrasound findings to better characterize the underlying shock state.