Home
|
Inbox
|
Search
|
View Abstract
Point of Care Echocardiography: An Essential Extension of the Physical Exam in Shock
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A3430 - Point of Care Echocardiography: An Essential Extension of the Physical Exam in Shock
Author Block: M. Reaume, C. Di Felice, T. Melgar; Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
Point of care (POC) echocardiography should be an integral part of the physical exam in all critically ill patients, particularly those in shock, where obtaining information about the patient’s cardiac function is invaluable. We present a case of refractory shock secondary to underlying cardiac tamponade diagnosed by bedside echocardiogram.
A 58-year-old female presented to the emergency department (ED) with dyspnea and cough. She was found to have a large right upper lobe lung mass with mediastinal lymphadenopathy, as well as pleural and pericardial effusions. She was discharged in stable condition with outpatient oncology follow-up. Two days later, she presented to the ED with worsening dyspnea, and was found to be tachycardic, hypotensive, and hypoxic, with profound leukocytosis and lactic acidosis. A repeat CT scan of the chest identified the interval development of new patchy ground-glass opacities, as well as acute bilateral subsegmental pulmonary emboli. Despite several hours of therapy for multifactorial shock presumed to be secondary to sepsis and pulmonary emboli (including broad-spectrum antibiotics, intravenous heparin, and five liters of crystalloid) she remained hypotensive with worsening lactic acidosis. She was subsequently transferred to the intensive care unit at our facility for further management. On initial evaluation following transfer, POC echocardiography identified tamponade physiology with near complete right ventricular diastolic collapse. Emergent pericardiocentesis led to immediate improvement in the patient’s hemodynamics. She was ultimately found to have metastatic adenocarcinoma of the lung with malignant pericardial effusion causing obstructive shock from cardiac tamponade.
The use of POC echocardiography can rapidly identify potential acute pathologies that may be responsible for clinical deterioration. Its use should continue to be emphasized, particularly in smaller and more rural facilities, where achieving a timely and accurate diagnosis can be life saving. It can also help to ensure a safe transition to critical care, especially in settings where a formal echocardiogram may not be readily available. In our case, the patient had an extensive workup that included numerous serum studies, x-rays, and CT scans, yet the underlying diagnosis was ultimately made at the bedside.
Author Block: M. Reaume, C. Di Felice, T. Melgar; Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
Point of care (POC) echocardiography should be an integral part of the physical exam in all critically ill patients, particularly those in shock, where obtaining information about the patient’s cardiac function is invaluable. We present a case of refractory shock secondary to underlying cardiac tamponade diagnosed by bedside echocardiogram.
A 58-year-old female presented to the emergency department (ED) with dyspnea and cough. She was found to have a large right upper lobe lung mass with mediastinal lymphadenopathy, as well as pleural and pericardial effusions. She was discharged in stable condition with outpatient oncology follow-up. Two days later, she presented to the ED with worsening dyspnea, and was found to be tachycardic, hypotensive, and hypoxic, with profound leukocytosis and lactic acidosis. A repeat CT scan of the chest identified the interval development of new patchy ground-glass opacities, as well as acute bilateral subsegmental pulmonary emboli. Despite several hours of therapy for multifactorial shock presumed to be secondary to sepsis and pulmonary emboli (including broad-spectrum antibiotics, intravenous heparin, and five liters of crystalloid) she remained hypotensive with worsening lactic acidosis. She was subsequently transferred to the intensive care unit at our facility for further management. On initial evaluation following transfer, POC echocardiography identified tamponade physiology with near complete right ventricular diastolic collapse. Emergent pericardiocentesis led to immediate improvement in the patient’s hemodynamics. She was ultimately found to have metastatic adenocarcinoma of the lung with malignant pericardial effusion causing obstructive shock from cardiac tamponade.
The use of POC echocardiography can rapidly identify potential acute pathologies that may be responsible for clinical deterioration. Its use should continue to be emphasized, particularly in smaller and more rural facilities, where achieving a timely and accurate diagnosis can be life saving. It can also help to ensure a safe transition to critical care, especially in settings where a formal echocardiogram may not be readily available. In our case, the patient had an extensive workup that included numerous serum studies, x-rays, and CT scans, yet the underlying diagnosis was ultimately made at the bedside.
|
Home
|
Inbox
|
Search
|