CASE REPORT: TO RUSH OR NOT TO RUSH


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!