Critical Care
The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
May 2018 Critical Care Case of the Month
Lacey Gagnon APRN, CNP
Theo Loftsgard APRN, CNP
Department of Anesthesiology and Critical Care
Mayo Clinic Minnesota
Rochester, MN USA
Chief Complaint
Shortness of breath
History of Present Illness
The patient is a 44-year-old woman who was admitted with a history of “pericarditis”. She has a several years history of progressive shortness of breath, abdominal distention and lower extremity edema.
Past Medical History, Social History and Family History
She has a history of obesity, poorly controlled type 2 diabetes, uterine fibroids and hypertension. She does not smoke but does have 1-2 alcoholic beverages per day. Family history is noncontributory.
Physical Examination
- Vital signs: pulse 96 beats/min, blood pressure 110/85 mm Hg, temperature 37° C, respirations 18 breaths/min.
- Neck: there is jugular venous distention with a positive hepatojugular reflux.
- Lungs: rales at both bases.
- Heart: regular rhythm without murmur.
- Abdomen: Distended. Shifting dullness is present.
- Extremities: 2-3 pretibial pitting edema.
Chest Radiography
Chest x-ray shows a small right pleural effusion with mild vascular congestion at the bases. Heart size is normal.
Which of the following should be performed?
Cite as: Gagnon L, Loftsgard T. May 2018 critical care case of the month. Southwest J Pulm Crit Care. 2018;16(5):245-51. doi: https://doi.org/10.13175/swjpcc048-18 PDF