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Postgraduate Education Corner: Ultrasound Corner |

A Man in His 40s With a History of Hypertension and Alcohol Dependency Presenting to the ED With Respiratory DistressHypertension, Alcohol, and Respiratory Distress

Ariel L. Shiloh, MD; Massoud G. Kazzi, MD; Roshen Mathew, MD; Lewis A. Eisen, MD, FCCP; Anthony J. Carlese, DO, FCCP
Author and Funding Information

From the Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Jay B. Langner Critical Care Service, Montefiore Medical Center, Bronx, NY.

Correspondence to: Ariel L. Shiloh, MD, Division of Critical Care Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; e-mail: ashiloh@montefiore.org


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


Chest. 2014;145(2):e3-e6. doi:10.1378/chest.13-2089
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Extract

A man in his 40s with a history of hypertension and alcohol dependency presented to the ED with respiratory distress, confusion, and vomiting. Prior to arrival, the patient was reported to be intoxicated and vomiting, with concern for aspiration.

His initial BP was 140/90 mm Hg; heart rate, 155 beats/min; respiratory rate, 36 breaths/min; and temperature, 40°C. Oxygen saturation was 85% on a nonrebreather mask. The patient was somnolent, disoriented, and urgently intubated for airway protection and hypoxia. The ECG showed sinus tachycardia with a new incomplete right bundle branch block. Chest radiograph showed bilateral infiltrates with opacification of the right hemidiaphragm (Fig 1). WBC count was 4.5 × 103/μL. Alcohol level was 225 mg/dL, and creatinine level was 1.8 mg/dL.

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Figures

Tables

Video 1

Bedside ultrasound

Running Time: :23

Discussion Video

Ultrasound used to diagnose septic shock in the setting of ARDS.

Discussion Video 1

Apical four-chamber view of the heart, shows a tachycardic and hyperdynamic left ventricle with preserved systolic function

Running Time: :29

Discussion Video 2

Subcostal view of the heart at the IVC level and right atrial junction

Running Time: :29

Discussion Video 3

Junction of the IVC and right atrium

Running Time: :29

Discussion Video 4

Apical four-chamber view, shows the catheter at the entrance of the right atrium

Running Time: :33

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