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.

Rick Robbins, M.D. Rick Robbins, M.D.

Ultrasound for Critical Care Physicians: A Tempting Dilemma

Issam Marzouk MD

Lana Melendres MD

Michel Boivin MD

 

Division of Pulmonary, Critical Care and Sleep

Department of Medicine

University of New Mexico School of Medicine

MSC 10-5550

Albuquerque, NM 87131 USA

 

A 46 year old woman presented with progressive severe hypoxemia and a chronic appearing pulmonary embolus on chest CT angiogram to the intensive care unit. The patient was hemodynamically stable, but had an oxygen saturation of 86% on a high-flow 100% oxygen mask. The patient had been previously investigated for interstitial lung disease over the past 2 year, this was felt to be due to non-specific interstitial pneumonitis. Her echocardiogram findings are as presented below (Figures 1 and 2).

Figure 1. Parasternal long axis view. Upper panel: static image. Lower panel: video.

 

 

Figure 2. Apical four chamber view. Upper panel: static image. Lower panel: video

 

The patient had refractory hypoxemia despite trials of high flow oxygen and non-invasive positive pressure ventilation. She had mild symptoms at rest but experienced severe activity intolerance secondary to exertional dyspnea. Vitals including blood pressure remained stable and normal during admission and the patient had a pulsus paradoxus measurement of < 10 mmHg. She had previously had an echocardiogram 6 months before that revealed significant pulmonary hypertension.

What would be the most appropriate next step regarding management of her echocardiogram findings? (click on the correct answer to move to the next panel)

  1. Diagnostic pericardiocentesis
  2. Urgent therapeutic pericardiocentesis
  3. Avoid pericardiocentesis at this time
  4. Urgent thrombolysis with tissue plasminogen activator

Reference as: Marzouk I, Melendres L, Boivin M. Ultrasound for critical care physicians: a tempting dilemma. Southwest J Pulm Crit Care. 2014;9(3):193-6. doi: http://dx.doi.org/10.13175/swjpcc128-14 PDF

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Rick Robbins, M.D. Rick Robbins, M.D.

Ultrasound for Critical Care Physicians: Sickle Cell Crisis

A 32 year old man was admitted a week earlier with sickle cell pain crisis. He had developed increasing dyspnea, oxygen desaturation and bilateral pulmonary infiltrates.  He had a pulseless electric activity code blue and an ultrasound of the heart was obtained (Figure 1).

Figure 1. Subxiphoid view ultrasound of the heart.

What does the ultrasound show?

  1. Aortic dissection
  2. Aortic stenosis
  3. Enlarged left ventricle
  4. Enlarged right ventricle
  5. Pericardial effusion

Reference as: Raschke RA. Ultrasound for critical care physicians: sickle cell crisis. Southwest J Pulm Crit Care. 2013:7(2):110-1. doi: http://dx.doi.org/10.13175/swjpcc113-13 PDF

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