Case report: To RUSH or not to RUSH….
here is a challenging case I had a short while ago, did the RUSH exam save the day? you decide
72yo male: small hospital presentation: ischemic chest pain, IHD history, ECG looked something like this:
Admitted for NSTEMI work up.
developed a fever, cough, WCC 29, initial trop 1500. Discussed with cardiologist who recommended focus on treating the sepsis, patient was referred to my hospital for treatment of pneumonia.
Arrival at my hospital:
- SOB, increased WOB
- febrile to 38.5,
- hypotensive, anuric, lactate 5,
- 2nd troponin 2100.
- ECG now showing something like this:
NOW: at this stage in the game, things are not adding up to me: I have got a guy in shock with elements suggestive of distributive, obstructive and cardiogenic cause…. what to do!!! oh, right, this is an Ultrasound blog. (click to view)
So what next:
a) fluids, ABs and pressors
c) lay into the cardiologist and get them to open the cath lab
d) hand patient over and go home!
put your answers in the comments section, I will post the outcome to this case in the comments section in 2 days time!