How to perform

DVT

The final part of the Rush protocol is the assessment of the big vessels; looking at the abdominal aorta for aneurysm or dissection, and at the femoral and popliteal veins for deep vein thrombosis (DVT), using the curvilinear probe. 

The assessment of the pipes looks to answer the following questions?

• Is there an aortic aneurysm or dissection?
• Is there a DVT in a large vein?

Abdominal Aorta Aneurysm (AAA)

A detailed review of how to perform a AAA assessment is available in the RCEM Learning Session Abdominal Aorta Aneurysm assessment

The recommended scanning style for the RUSH protocol is to sweep down from the xiphoid to the bifurcation of the aorta.

DVT

An addition to the original RUSH protocol is a limited two-point compression scan to look for DVT at:

• Common femoral vein in the inguinal canal
• Popliteal vein in the popliteal region

Learning bite

The presence of echogenic material in the vein, or the lack of collapsibility of the vein on applying pressure is indicative of DVT.

Examples

Is there an aortic aneurysm or dissection?

This image shows a 10cm abdominal aortic aneurysm with echogenic smoke produced by the passing blood cells and platelets.

Image courtesy of Brian Toston : thepocusatlas.com

Is there a DVT in a large vein?

This image shows a left common femoral vein which is not fully compressible confirming DVT.

Image courtesy of Dr Justin Bowra et al : thepocusatlas.com