Thread by @EM_RESUS

Here’s a great #Echo of a young lady who suddenly collapsed to the ground in Cardiac Arrest. Bystander CPR was performed and 911 was called. Paramedics shock her once for pulseless VT and get ROSC on the scene. She’s intubated, in shock, on an Epi drip.

What’s the diagnosis?

The RV is very dilated with poor systolic function. The RA is also very big. The LV is Hyperdynamic with no obvious wall motion abnormality. This appearance of Severe Right Heart Strain is common during arrest, but when it persists AFTER ROSC, you must think Massive PE!

[2/x]

But the other caveat is that this Right Heart Strain could also be the result of *chronic* pulmonary hypertension.

So here’s what we did: We placed an Arterial Line & added a Norepi drip. We notified the CT techs that she needed to be next in line for an Emergent CTPA...

[3/x]

Our CT Room is right across from our Resuscitation Bays, which makes this strategy a valid option.

We got the scan which showed massive showering of bilateral segmental and subsegmental PEs. The clots were too distal for intervention so we went ahead with Systemic tPA...

[4/x]

Over the next several hours she had dramatic improvement in hemodynamics, allowing drastic weaning of pressor support, and she continued showing signs of increased neurologic activity.

By the time she went up to the ICU she was maintained on only very low dose Norepi...

[5/x]

I share this case as an example of how powerful Bedside Echo can be when caring for critically ill patients. So the message I want to get out is this:

If you take care of critical patients, please take the time to learn Basic Bedside Echo. I promise you will save lives.

[End]