This week’s case comes from Drs. Arshed and Mayr.
This is a 69 yo M, admitted for cabgx4, who’s post-operative course was complicated by heart failure (ef 30%) and new onset atrial fibrillation/flutter with RVR. Patient was started on amiodarone, digoxin and lopressor, and eventually converted to sinus. He was eventually transferred to the step-down unit. The next day a condition A was called. Nurse reported noticing the patient Brady’d down and went into asystole. CPR was started right away and Rosc achieved in 7 mins. Patient transferred back to ICU, placed on vent and found to be persistently hypoxemic, hypotensive, bradycardic with Pip 35 Pplat 32. Good lung sounds noted b/l. POCUS of the lungs was performed by the team with the following clips obtained:
1. What probe is being used?
2. What is your interpretation?
3. How/ should POCUS potentially guide your next steps (management, further evaluation, etc)?
4. How confident would you be to act (base don your reply to #3), based on these POCUS clips?
PLEASE post your thoughts & comments to the blog. I will be posting the “answers” in 1 week, on 4/16/18.