Accuracy of rapid ultrasound in shock (RUSH) exam for diagnosis of shock in critically Ill patients

Background: Rapid ultrasound in shock (RUSH) is the most recent emergency ultrasound protocol, designed to help clinicians better recognize distinctive shock etiologies in a shorter time frame. Objectives: In this study, we evaluated the accuracy of the RUSH protocol, performed by an emergency physician or radiologist, in predicting the type of shock in critical patients. Patients and Methods: An emergency physician or radiologist performed the RUSH protocol for all patients with shock status at the emergency department. All patients were closely followed to determine their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RUSH for diagnosis of each case. Results: We performed RUSH on 77 patients. Kappa index was 0.71 (P Value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97 yet it had a lower PPV. For shock with distributive or mixed etiology, RUSH showed a PPV of 100 but it had low sensitivity. Subgroup analysis showed a similar Kappa index for the emergency physician and radiologist (0.70 and 0.73, respectively) in performing rush. Conclusions: This study highlights the role of the RUSH exam performed by an emergency physician, to make a rapid and reliable diagnosis of shock etiology, especially in order to rule out obstructive, cardiogenic and hypovolemic shock types in initial exam of shock patients. Copyright © 2015, Trauma Monthly

Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients

Background: Rapid Ultrasound in Shock (RUSH) is a recently reported emergency ultrasound protocol designed to help clinicians better recognize distinctive shock etiologies in a short time. We tried to evaluate the accuracy of early RUSH protocol performed by emergency physicians to predict the shock type in critically ill patients. Materials and Methods: Our prospective study was approved by the ethics committee of trauma research center, Baqiyatallah University of Medical Science, Iran. We enrolled 52 patients with shock state in the emergency department from April 2013 to October 2013. We performed early bed-side sonographic examination for participants based on RUSH protocol. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final diagnosis. Agreement (Kappa index) of initial impression provided by RUSH with final diagnosis, and also sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RUSH for diagnosis of each shock type were calculated. Results: Fifty-two patients were enrolled in our study. Kappa index was 0.7 (P value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic and obstructive shocks, the protocol had sensitivity of 100 but had lower PPV. For shocks with distributive or mixed etiology, RUSH showed PPV of 100 but had low sensitivity. For cardiogenic shocks, all reliability indices were above 90. Conclusion: We highlight the role of RUSH examination in the hands of an emergency physician in making a rapid diagnosis of shock etiology, especially in ruling out obstructive, cardiogenic, and hypovolemic types

Studying the impacts of the rainbow trout farms effluents on Sabzkooh River in Charmahal-O-Bakhtiari Province

Sabzkooh in Ardal and Gandoman region in Charmahal province with annual production of 1300 metric tons of rainbow trout, is one of the most important rivers in the province. The effects of fish farms effluent on the river water quality and the possibilities to develop or limit the existing ones were studied. Flora and fauna of the river including Phyto and zooplankton, macroinvertebrates and fishes were sampled and studied. Moreover some key physico-chemical water quality parameters, concentrations of stable pollutants (heavy metals: Zn, Cu, Fe, Pb, Cd and agricultural poisons (herbicides or pesticides: DDT, Lindane, Alderine and indosulfate) and Coliform contamination were also measured. All phytoplankton genus were of tow taxa, Cianophyta and Chrysophyta and zooplankton fauna belonged to Rotatoria, Protozoa and meroplanktonic chirinomids and nematodes. Four fish species from 3 families were identified of which rainbow trout had the highest relative frequency (94.6%).All the measured heavy metals including Zn, Cu, Fe, Pb, Cd and the agricultural poisons concentrations such as DDT, Lindane, Alderine and indosulfate were lower than the hazardous level suggested for the surface waters. According to the benthic macroinvertebrates populations study, stations at downstream (no. 6 and 7) which received the Chartakhteh and Rudarud farms effluent had least EPT richness and the hilsenhof family level biotic index at this locations was greater than 5.25, classifying them as having organic pollution. Even though measured key physico-chemical parameters such as nutrients (N and P compounds and BOD5) in the receiving stations and effluent water never exceed the maximum permitted range but in downstream stations these factors were very close to the range. One way analyze of variance (P 95%) for TN, TP, No_2, NH_4, BOD_5, pH, PO_4 and Ec revealed no significant differences between stations before and just after receiving the effluents, however these parameters in the effluents themselves significantly differ from upstream stations 1,2 and 3 proving relatively lower organic pollution and the potential for constructing new farms or expanding the existed ones in upstream region from Chartagh to Dehnoo. At downstream from Dehnoo to Rudarud and lower parts, dense trout farm effluents in addition with point and non point pollution (municipal, agricultural and other coming run off from the catchments area) had remarkable effects on the river water quality and as a result no farm construction or expansion is recommended. To avoid or reduce the existing farms effects on the river system there should be certainly some remediation actions carried out. Constructing sedimentation ponds before releasing the effluents, obeying the rule of water extracting, preventing fish escape, increasing feeding efficiency and controlling the lateral inlets from catchments area which are potentially pollutant, should be considered to improve the situation and prevent further environmental problems caused by fish farms effluent in these area