title: The impact of using RUSH protocol for diagnosing the type of unknown shock in the emergency department.
abstract: Clinical assessment and classification of shock is extremely difficult to conduct on critically ill patients especially upon arrival at the emergency department. Resuscitative point-of-care ultrasound could be used for rapid initial diagnosis and better management. In this study, the results of using the RUSH (Rapid Ultrasound in Shock) exam to determine the type of shock in the emergency department are compared to the final diagnosis of patients. This was a single-center prospective study in which all patients with an unknown type of shock and no prior treatment were included. Parallel to the standard resuscitative management and diagnosis of the emergency team, the RUSH exam was performed blindly on the patient by an emergency medicine staff who was not part of the patient's caregiving team. The results of the RUSH exam were then compared to the final diagnosis of the patients and the 48-h outcome. Twenty-five patients were enrolled in this study. The overall kappa correlation of the RUSH exam compared with the final diagnosis was 0.84 which is an almost perfect agreement. The overall sensitivity of the RUSH exam was 88 % and the specificity was 96 %. Although the mortality rate was 64 %, there was not a significant relationship between mortality and the protocol used for diagnosis. The RUSH exam could be used in emergency wards to detect types of shock.
authors: Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
authors: Shahram
authors: S
authors: Bagheri-Hariri
authors: Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
authors: Meysam
authors: M
authors: Yekesadat
authors: Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. shervinf27@yahoo.com.|Emergency Department, Imam Khomeini Complex Hospital, Bagherkhan Ave, Tehran, 1419733141, Iran. shervinf27@yahoo.com.
authors: Shervin
authors: S
authors: Farahmand
authors: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors: Mona
authors: M
authors: Arbab
authors: Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
authors: Mojtaba
authors: M
authors: Sedaghat
authors: Medical Radiology Department, Tehran University of Medical Sciences, Tehran, Iran.
authors: Neda
authors: N
authors: Shahlafar
authors: Anesthesiology Department, Tehran University of Medical Sciences, Tehran, Iran.
authors: Alireza
authors: A
authors: Takzare
authors: Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
authors: Seyedhossein
authors: S
authors: Seyedhossieni-Davarani
authors: Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.|Prehospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors: Amir
authors: A
authors: Nejati
mesh_terms: D002985:Clinical Protocols; D016638:Critical Illness; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012769:Shock / Q000000981:diagnostic imaging* / Q000628:therapy; D014463:Ultrasonography
keywords: Emergency department; RUSH exam; Resuscitative ultrasound; Shock state