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. 🌐 Connect with Us 🌐 If you want more education goodness, check out the links below! Check out our courses here: https://courses.coreultrasound.com Check out our question bank here: https://courses.coreultrasound.com/collections/q-bank Check out our FREE content on our website: https://www.coreultrasound.com Check out our in-person course in San Diego, Ca on Nov 12-14 2026 here: https://www.soundandsurf.com/essentials-2026 Disclaimer: By watching this (or any Core Ultrasound) education video or reading any of our content, you agree not to use this information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer applies to any and all content produced or discussed by Core Ultrasound. Under no circumstances shall any of the contributors on this website be responsible for damages arising from use of any topic discussed. This content should not be used in any legal capacity whatsoever, including but not limited to establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made by Core Ultrasound. The content of this website is formed by our own opinions and do not represent the views or opinions of any institutions we may be affiliated with.

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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