When a patient rolls in hypotensive and tachycardic and you don't know why, the RUSH exam may be the most important tool in your hands. RUSH, Rapid Ultrasound in Shock and Hypotension, is a rapid, systematic bedside ultrasound protocol designed for exactly that moment.

The HIMAP mnemonic breaks it down:

(H)eart: The highest-yield component. Look for pericardial effusion/tamponade, right heart strain (think PE), or low EF. (I)VC: Not just a volume status tool, it reflects CVP and helps differentiate obstructive, distributive, and hypovolemic shock. Put a shocked septic patient on pressors and watch the IVC fill up even before you've given a drop of fluid. (M)orrison's Pouch aka the FAST Exam: Free fluid in the abdomen isn't just for trauma. Ruptured ectopic pregnancy, splenic rupture, ruptured bowel, and AAA all show up here. (A)orta: Rare but critical. Ruptured AAA and dissection can present as undifferentiated shock, and dissection matters more than people think, especially in patients with stroke-like symptoms plus pain. (P)ulmonary: Rule out tension pneumothorax

At the bedside, ultrasound is the fastest and most accurate tool available for undifferentiated shock. Learn HIMAP. Use it early.

🎧 Happy scanning.

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