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Postgraduate Education Corner: Ultrasound Corner |

A Woman in Her 60s With Septic Shock, Abdominal Pain, and a Positive UrinalysisWoman With Septic Shock, Pain, Positive Urinalysis

Yonatan Y. Greenstein, MD; Seth J. Koenig, MD, FCCP
Author and Funding Information

From the Division of Pulmonary, Critical Care, and Sleep Medicine, Hofstra North Shore – Long Island Jewish Health System, New Hyde Park, NY

Correspondence to: Yonatan Y. Greenstein, MD, Hofstra North Shore – Long Island Jewish Health System, Division of Pulmonary, Critical Care, & Sleep Medicine, 410 Lakeville Rd, Ste 107, New Hyde Park, NY 11040; e-mail: lungdoc@yonatangreenstein.com


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


Chest. 2014;145(3):e7-e9. doi:10.1378/chest.13-2455
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Extract

A woman in her 60s, with a past medical history of hypertension, presented to the ED complaining of a 1-day history of fevers, chills, nausea, vomiting, and abdominal pain. She was unable to further characterize the pain; however, she did deny the presence of diarrhea and dysuria.

In the ED, the patient was febrile to 39.2°C (102.6°F), tachycardic to 110 beats/min, hypotensive to BP of 80s/50s mm Hg, with mild tachypnea and normal oxygenation on room air. She was given multiple boluses of normal saline in the ED. Laboratory data were notable for a WBC count of 34,000/μL; serum creatinine level, 2.25 mg/dL; venous lactate level, 5.9 mmol/L; and a grossly positive urinalysis. A norepinephrine drip was started, blood and urine cultures were obtained, and the patient was given broad-spectrum antibiotics. Upon arrival in the medical ICU, a focused, goal-directed ultrasound study was performed to further evaluate her shock state and to guide management (Videos 1-7, Video Set 1).

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Video 1 - 7

Focused, goal-directed ultrasound study

Discussion Video

Next step is urgent source control with a percutaneous nephrostomy tube

Discussion Video 1

Focused whole body ultrasound study

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