Critical Care Case Studies

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Correct answer: E Doppler echocardiogram can be useful in supporting the diagnosis of submassive and massive pulmonary embolism, especially in the cases where a contrast chest CT cannot be performed immediately.

Findings on Doppler echocardiogram demonstrate acute right ventricular pressure overload Echocardiographic findings may also help to distinguish the chronicity of events in patients with massive pulmonary embolus, which may be of clinical relevance regarding therapy [3].

Although in the past, peri-operative mortality was a high as 57%, some experienced centers now report peri-operative mortality of approximately 6% [33].

However, with the use of cardiopulmonary bypass and increasing surgical expertise, mortality and morbidity from surgical embolectomy can be minimized,[18,19] and may offer benefit particularly to those patients with evidence of pulmonary hypertension [18].

Small studies, including case series and controlled trials, have evaluated the efficacy of intrapulmonary thrombolysis [21-23].

Although clinical endpoints such as mortality were not evaluated, these studies suggest equivalent or superior radiographic resolution of thrombolysis compared to systemic thrombolysis.

HOSPITAL COURSEAfter admission to the ICU, the patient received an intravenous infusion of unfractionated heparin drip and an intravenous infusion of norepinephrine at 5 micrograms/minute for hemodynamic support.

A Foley catheter was placed with urine output remaining 2g/d L hemoglobin drop­) developed.

She was brought to the emergency department, where vital signs were notable for temperature of 100.9ºF, HR=142/min, BP=90/60 mm Hg after intravenous fluids, with oxygen saturation of 99% while breathing 100% oxygen via non-rebreather mask.

Columbia University College of Physicians and Surgeons HISTORY:55-year-old female nursing home resident with past medical history of AIDS, dilated cardiomyopathy (estimated left ventricular ejection fraction 15% on a previous transthoracic echocardiogram), and prior deep venous thrombosis (DVT) was found to be hypotensive and in respiratory distress while at her skilled nursing facility.

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