Case Study - Adult - Dilemma - Emergency Department

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Dilemma - Emergency Department
42 year old male with acute onset on breathlessness, inability to lie flat, headache and muscle aches and generally feeling flu-like for 36 hours.

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  • Hypodynamic, Hypovolemic circulationLow MD – 16 (Typical 14-22) Low SV – 45(Typical 0.9 - 1.75 ml/kg)Low SVI – 24 (Typical 30-55)Low FTc – 231 (Typical 425-475)High SVR – 1735 (Typical 1000-1800)Low CO – 5.3 (Typical 2.5-6.0)Low CI – 2.8 (Typical 2.4-3.6)
  • Case Study - Adult - Dilemma - Emergency Department

    1. 1. Dilemma - ED Presentation 42 year old male with acute onset on breathlessness, inability to lie flat, headache and muscle aches and generally feeling flu-like for 36 hours. BP 105/50 O2 Sats 92% on 15L/min of O2 Temp 37.5www.uscom.com.au The Measure of Life
    2. 2. Dilemma - EDwww.uscom.com.au The Measure of Life
    3. 3. Dilemma - ED Results Low MD, SV, short FTc and high SVR. Hypovolemia? Clinical Exam Neck veins distended, Liver a little distended CVP 16mmHg Clinical signs of fluid overload but USCOM signs of fluid under load? What clinical state correctly gives the clinical signs of fluid overload but USCOM signs of fluid under load? Conclusion There are two possible conditions that cause this clinical appearance but the correct one is confirmed by the USCOM.www.uscom.com.au The Measure of Life
    4. 4. Dilemma - ED Tamponade The tamponade prevents the ventricle filling so the venous pressure is high. What does enter the ventricle is pumped out rapidly because inotropy is OK. So the FTc is short. The SV is low, but CI is maintained by the increased HR. Pulmonary embolus A pulmonary embolus can present with a similar clinical picture due to prevention of adequate left ventricular preload. By measuring the pulmonary flow, a much higher FTc is found as the right ventricle struggles to empty against the resistance of a pulmonary embolus.www.uscom.com.au The Measure of Life

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