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Ultrasound Corner |

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Clarisse J. Glen, MD; Samuel O. Acquah, MD; Pierre Kory, MD
Author and Funding Information

From the Division of Pulmonary, Critical Care and Sleep Medicine (Drs Glen, Acquah, and Kory), Beth Israel Medical Center, New York, NY.

Correspondence to: Pierre Kory, MD, Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Medical Center, 16th St at 1st Ave, New York, NY, 10003; e-mail: pkory@chpnet.org


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


Chest. 2013;143(2):e1-e3. doi:10.1378/chest.12-2981
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Extract

A 56-year-old man was brought to the ED after being found unconscious on the street. The initial neurologic exam resulted in a Glasgow Coma Scale score of 3. After endotracheal intubation for airway protection, a CT scan of the head revealed a large left-side intracranial hemorrhage with a 5-mm midline shift and the patient was transferred to our medical ICU for management. Soon after arrival, central venous access was attempted via a left subclavian vein approach because of insufficient peripheral access sites. Immediately after the procedure, severe hypotension (BP =62/46) and desaturation (oxygen saturation =65%) developed. Concern for an iatrogenic tension pneumothorax led to immediate preparation for needle decompression and chest thoracostomy-tube placement. During preparation, a team member performed a physical examination and a left-side chest ultrasound survey. Physical examination revealed presence of equal, bilateral breath sounds and the symmetric appearance of hemithorax dimensions. Ultrasound findings are shown in Videos 1-3.

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Figures

Tables

Video 1. Case patient ultrasound readings. Left 2nd intercostal space, mid-clavicular line.

Running Time: :23

Video 2. Case patient ultrasound readings. Left 4th intercostal space, mid-clavicular line.

Running Time: :22

Video 3. Case patient ultrasound readings. Left 4th intercostal space, anterior axillary line.

Running Time: :23

Introduction and Video 4

Running Time: 1:28

Video 5 Narration

Running Time: :30

Video 6

Running Time: 1:18

Video 7

Running Time: :41

Video 8

Video 9

Video 10

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