“Code Blue” in a 66-Year-Old Man in the Cardiology Department

Phan, Kim M.; Lam, Pamela V.; Kimura, Bruce J.

doi:10.1016/j.chest.2016.02.689

Cited by 1 publication

(1 citation statement)

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“…We, along with other practitioners, have found that in clinical situations where the patient's positioning is limited, placing the phase array probe in the subcostal area and obtaining the subcostal four-chamber view can provide useful information to guide resuscitation. 3 It should be noted that when body habitus limits the practitioner's ability to acquire even limited transthoracic echocardiogram views, intensivists with proper training in goal-directed transesophageal echocardiography would be able to obtain superior views; such views have been proven to be uniquely advantageous in directing care. 4 At the moment of the patient's profound bradycardia, hypotension, and impending cardiac arrest, POCUS was performed to explore the etiology of his shock and to guide resuscitation.…”

Section: Discussionmentioning

confidence: 99%

A Patient on Airway Pressure Release Ventilation With Sudden Hemodynamic Collapse

Chen

Mead

Gale

2017

Chest

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We present a case of a man in his 50s with past medical history significant for schizophrenia and hypertension who was recently diagnosed with mycosis fungoides vs primary cutaneous T-cell lymphoma with extensive metastasis. Patient was admitted to the medical ICU and treated for sepsis of unknown source, likely pneumonia. Wound cultures grew Pseudomonas, methicillinresistant Staphylococcus aureus, and Proteus. Laboratory results were notable for the following: WBC count, 88,000/mL; uric acid, 10.6 mg/dL; potassium, 5.3 mEq/L; phosphate, 6.5 mg/dL; lactate dehydrogenase, 693 U/L. The patient was started on broad-spectrum antibiotics and treated for sepsis and tumor lysis syndrome. An official echocardiogram on admission showed unremarkable results. The patient's clinical condition improved and he was transferred to the ward. Twenty-four hours after transfer to the ward, the patient was found to be tachypneic and was subsequently transferred back to the ICU, intubated for hypoxemic respiratory failure, and placed on airway pressure release ventilation (APRV). Pressure support was increased progressively because of profound hypoxemia. The patient's medical ICU course was further complicated by oliguric renal failure, requiring renal replacement therapy. Forty-eight hours after intubation, the patient developed bradycardia and hypotension. A point-of-care ultrasound (POCUS) was done on an emergency basis at the bedside (Video 1).

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Section: Discussionmentioning

confidence: 99%