Brad had a great case overnight. A 62 yo male was transferred to RMH from a regional hospital post respiratory arrest in ED. 20 mins of CPR --> ROSC with GCS improving to 13. Electively intubated for severe hypoxaemia. He had a past history of COPD and asthma.
On arrival at RMH he was tachycardia, BP 120/ on an adrenaline infusion.
Brad did an awesome bedside cardiac ultrasound:
Subcostal 4 chamber view showing a dilated RV, small hyper dynamic LV. The RV free wall is hypocontractile. But it is important to note that the RV free was is hypertrophied and trabeculated. This is consistent with the patient's hx of COPD and likely some pulmonary HT.
Along with this he had features consistent with RV pressure overload: dilated, non collapsing IVC, D shaped LV.
However, with features of chronic RV pressure overload, it is difficult to thrombolyse this haemodynamically unstable patient based on echo findings alone.
The patient had a CTPA which revealed bilateral proximal PEs. He was thrombolysed prior to transfer to ICU.
Fiona had a 40yo female patient today who presented with an episode of significant SOB while walking followed by a brief syncope. She had fibroid excision surgery February 2018. Previous surgery had lead to development of DVT. She was treated with clexane post operatively. She had noticed some calf pain over the weekend.
She was tachycardia 100 reg sats 92% on RA BP 114/57
CTPA revealed a saddle embolus
Cardiac ultrasound showed several features of massive PE.
PSAX: LV small and hyperdynamic. D shape to LV due to P overload in RV causing bowing of septum to L in systole.
PLAX showing a very dilated RV and hyper dynamic LV (kissing pap muscles). Note RV free was is not contracting much, there is not much change to RV cavity with systole.
PLAX hyper dynamic RV and LV due to sepsis for comparison