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).