🚨🚨🚨🚨another edition of #fromthetrenches🚨🚨🚨🚨
Recent case of mine —> clinical details altered for anonymity
59 year old male presents to ED with SOB. Family states was at home at fell in bathroom. Hx of HTN/DM. Unsure of meds or compliance to therapy. Arrival BP 79/42 😱😱
Recent case of mine —> clinical details altered for anonymity
59 year old male presents to ED with SOB. Family states was at home at fell in bathroom. Hx of HTN/DM. Unsure of meds or compliance to therapy. Arrival BP 79/42 😱😱
Patient was given IVF bolus but this worsened SOB—>started on Bipap—>intubation. Post tube pulse ox 77% on 100% and 10 PEEP 😫
Post tube CXR—->very convincing pulm edema
MICU called to help with oxygenation . Some concern for cardiac event but too hypoxic for Lab
Post tube CXR—->very convincing pulm edema
MICU called to help with oxygenation . Some concern for cardiac event but too hypoxic for Lab
I go and immediately walk PEEP up to 20.
Plat/driving pressures all improve with PEEP titration. Sats go from 77–>92. I’m happy.
Diurese, get some labs, little levo, +/- cath depending on what happens, and I’ll be back to the call room in no time.
Plat/driving pressures all improve with PEEP titration. Sats go from 77–>92. I’m happy.
Diurese, get some labs, little levo, +/- cath depending on what happens, and I’ll be back to the call room in no time.
BUT, I remember #echo first☝️☝️So, on bedside, there’s wildly diffuse B lines. Ok consistent with my CXR
Now cardiac
I’m no expert, but that looks weird?
Now cardiac
I’m no expert, but that looks weird?
Next
Color (still workin on my color skillzzz)
As you may be able to tell, not simple cardiogenic shock from HF or NSTEMI. LVOT VTI wasn’t even bad, quite good actually (35)
Good example of an acute valvular disaster with a blown open aortic valve.
Mitral had some regurgitate and I couldn’t get a view on the tricuspid.
Good example of an acute valvular disaster with a blown open aortic valve.
Mitral had some regurgitate and I couldn’t get a view on the tricuspid.
Teaching points:
1. Echo first always
2. Valvular disasters are an important consideration in acute resp distress/shock
3. Need to dx early so can get patient to place with appropriate therapies if needed
1. Echo first always
2. Valvular disasters are an important consideration in acute resp distress/shock
3. Need to dx early so can get patient to place with appropriate therapies if needed
@PulmCrit @PulmPEEPs @NidaQadirMD @IM_Crit_ @katiewiskar @williamkellymd @gretchemaben @cjosephy @khaycock2 @BKenigsberg @coreultrasound @UltrasoundJelly @IMPOCUSFocus @COREIMpodcast @IM_POCUS @chungk1031 @MDKrunalP @msiuba @nickmmark
@davidshoremd @emily_fri @accpchest @critconcepts @ThinkingCC @iceman_ex @BrownJHM @CriticalCareNow @POCUSJournal @POCUS_Society @pocusfoamed @CardioNerds @JAMACardio @CardioCrit @escardio @ogi_gajic @drshahrul80
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