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.