By Scott Flannagan
Peer reviewed by Chris Partyka.
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 focussing on treating the sepsis. Patient was referred to my hospital for treatment of pneumonia.
On arrival at my hospital:
SOB, increased WOB
hypoxic,
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!!!
PARASTERNAL LONG
PARASTERNAL SHORT
APICAL 4 CHAMBER VIEW
EXAMPLE OF ALL LUNG FIELDS
IVC
So what next:
a) fluids, ABs and pressors
b) lytics
c) lay into the cardiologist and get them to open the cath lab
d) hand patient over and go home!