An Observational Study of Patients Presenting in Hypotension and Shock to Emergency Room by Applying RUSH Protocol

Introduction: Care of the patient with shock can be one of the most challenging issues in emergency medicine. The early use of ultrasound at the bedside in such emergency is a very valuable tool to determine the type of shock. Rapid Ultrasound in SHock (RUSH) protocol done by emergency physicians is one such protocol which is being underused. Hence, we conducted this study to assess the effectiveness of the RUSH protocol for patients presenting with undifferentiated hypotension and shock. Materials and methods: This was prospective observational study done on a total of 100 patients presented with hypotension and shock. We performed an early bedside sonographic examination for participants based on RUSH protocol and type of shock was determined. Then the definitive interventions were performed as per the type of shock. The outcome measures were determined either till the survival to discharge from the hospital or till the in-hospital death of the patient. The data was analysed using SPSS version25. Results: In this study, the type of shock most commonly found overall was hypovolemic shock (40%) followed by cardiogenic shock (27%) and distributive shock (17%). Contractility of left ventricle, size of right ventricle, inferior venacava caliber, hemoperitoneum, pneumothorax, hemothorax, pulmonary edema, pleural effusion and lungs consolidation were statistically significant in determining the type of shock except cardiac tamponade, abdominal aortic aneurysm/dissection and deep vein thombosis. Majority of the interventions performed were fluid resuscitation (41%), vasopressors and inotropes (28%) and laparotomy (9%) and were statistically significant (p=0.001). Among all patients, 73% survived and 27% died. The outcome was statistically significant (p=0.002). Conclusion: RUSH protocol used for undifferentiated hypotension and shock is an effective tool at the bedside as an early approach to diagnose the type of shock. It will also help in determining early definitive interventions in shock states and thereby having better patient outcomes.