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Postgraduate Education Corner: Ultrasound Corner |

ShockShock: A Case of Mistaken Identity: A Case of Mistaken Identity

Seth J. Koenig, MD, FCCP; Mangala Narasimhan, MD, FCCP; Paul H. Mayo, MD, FCCP
Author and Funding Information

From the Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore Long Island Jewish Medical Center, New Hyde Park, NY.

Correspondence to: Seth J. Koenig, MD, FCCP, Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra North Shore Long Island Jewish Medical Center, 410 Lakeville Rd, Ste 107, New Hyde Park, NY 11040; e-mail: Skoenig@nshs.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):e1-e3. doi:10.1378/chest.12-2878
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Extract

A 66-year-old woman had a brief syncopal episode after standing up from the toilet. She awoke in seconds and noted no chest pain or shortness of breath. On presentation to the ED, she had a BP of 90/60 mm Hg, a regular heart rate of 115 beats/min, temperature of 37.2°C, and a respiratory rate of 26 breaths/min. Her oxygen saturation on 4 L nasal cannula was 91%. The physical examination was otherwise unremarkable. Her chest radiograph was clear, and the ECG showed sinus tachycardia without other abnormality. Laboratory values were as follows: WBC count, 12.7 K/μL; lactate, 3.4 mmol/L; and creatinine, 2.2 mg/dL; urinalysis results were 25 WBC per high-powered field. She was given antibiotics for presumed septic shock with a urinary tract infection, and over the next few hours, per sepsis bundle protocol, she was given a total of 3 L of normal saline. The patient remained hypotensive. Norepinephrine was started at 0.5 μg/kg/min while fluid resuscitation with normal saline was continued. The patient was admitted to the medical ICU with a diagnosis of septic shock. The intensivist performed an immediate bedside ultrasound examination to diagnose and guide management of her hypotension and hypoxemia (Videos 1-3).

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Videos 1-3 bedside ultrasound at presentation

Video 4 follow up area to examine with ultrasonography

Video 5 discussion video

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