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.
Ultrasound for Critical Care Physicians: Ghost in the Machine
Ross Davidson, DO
Michel Boivin, MD
Division of Pulmonary, Critical Care and Sleep Medicine
University of New Mexico School of Medicine
Albuquerque, NM USA
A 53-year-old woman presented to the emergency department after a sudden cardiac arrest at home. The patient had a history of asthma and tracheal stenosis and had progressive shortness of breath over the previous days. The patient’s family noticed a “thump” sound from the patient’s room, and found her apneic. They called 911 and began cardiopulmonary resuscitation. Paramedics arrived on the scene, found an initial rhythm of pulseless electrical activity. The patient eventually achieved return of spontaneous circulation and was transported to the hospital. On arrival the patient was in normal sinus rhythm, with a heart rate of 110 beats per minute. Blood pressure was 80/45 mmHg, on an epinephrine infusion. The patient was afebrile, endotracheally intubated, unresponsive and ventilated at 30 breaths per minute. An initial chest radiograph was compatible with aspiration pneumonitis and a small pneumothorax. Initial electrocardiogram on arrival had 1mm ST-segment depressions in leads V4 to V6. Transthoracic echocardiography was unsuccessful due to patient’s habitus and mechanical ventilation. Because of the patient’s hemodynamic instability and unknown cause of cardiac arrest, an urgent trans-esophageal echocardiogram (TEE) was performed (Videos 1-3).
Video 1. Mid-esophageal 4-chamber view of the heart.
Video 2. Upper esophageal long-axis view of the pulmonary artery and short axis view of the ascending aorta.
Video 3. Upper esophageal short axis view of the pulmonary artery with the ascending aorta in long axis.
Based on the images presented what do you suspect is the etiology of the patient’s cardiac arrest? (Click on the correct answer for an explanation-no penalty for guessing, you can go back and try again)
Cite as: Davidson R, Boivin M. Ultrasound for critical care physicians: ghost in the machine. Southwest J Pulm Crit Care. 2018;16(2):76-80. doi: https://doi.org/10.13175/swjpcc027-18 PDF
Ultrasound for Critical Care Physicians: Unchain My Heart
William Mansfield, MD
Michel Boivin, MD
Division of Pulmonary, Critical Care and Sleep Medicine
Department of Medicine,
University of New Mexico School of Medicine
Albuquerque, NM USA
A 46-year-old man presented after a motor vehicle collision. He suffered abdominal injuries (liver laceration, avulsed gall bladder) which were successfully managed non-operatively. The patient remained intubated on mechanical ventilation and remained hypotensive after the injuries resolved. The patient required norepinephrine at low doses to maintain a normal blood pressure. It was noted the patient had a history of remote tricuspid valve replacement. A bedside echocardiogram was then performed to determine the etiology of the patient’s persistent hypotension after hypovolemia had been excluded.
Video 1. Apical four chamber view centered on the right heart.
Video 2. Apical four chamber view centered on the right heart, with color Doppler over the right atrium and ventricle.
Video 3. Right ventricular inflow view.
Figure 1. Continuous-wave Doppler tracing through the tricuspid valve.
What tricuspid pathology do the following videos and images demonstrate? (Click on the correct answer to proceed an explanation and discussion)
Cite as: Mansfield W, Boivin M. Ultrasound for critical care physicians: unchain my heart. Southwest J Pulm Crit Care. 2017;14(2):60-4. doi: http://doi.org/10.13175/swjpcc013-17 PDF