Patient sent up to the MICU with presumed distributive shock from sepsis
Always remember to perform a quick POCUS to make sure you're not missing something
1) IVC very plump with retrograde material without respiratory variation, hence not looking preload-depleted
Parasternal long axis: shows no large discernable effusion to suggest tamponade, EPSS performed in M Mode showed normal LVEF
But look at that Right ventricle!!
Parasternal short axis: shows definite septal flattening in diastole and both parasternal views showed an RV:LV ratio >0.9 @EM_RESUS @PulmCrit
Finally Apical 4 chamber view confirms all the previous findings suggestive of massive PE leading to significant RV pressure overload and hemodynamic compromise
The patient's UA showed signs of possible infection and started the narrative for septic shock but this underscores the usefulness of a simple bedside echo to help determine shock physiology and etiology
@JulioHuapayaMD @HFHPulmCC @DrBryanMSU #FOAMcc #FOAMed #CriticalCare
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