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Postgraduate Education Corner: Ultrasound Corner |

A Postoperative Patient Decompensates During Transfer From an Outside HospitalCritical Care Ultrasound for Diagnosis of Shock

Thomas Edrich, MD; Pingping Song, MD; Martin W. Dünser, MD; Bernhard Bacher, MD; Christian Torgersen, MD
Author and Funding Information

From the Department of Anesthesia, Perioperative and Pain Medicine (Drs Edrich and Song), Brigham and Women’s Hospital, Boston, MA; and the Department of Anesthesiology, Perioperative Medicine and General Intensive Care Medicine (Drs Dünser, Bacher, and Torgersen), Salzburg General Hospital and Paracelsus Private Medical University, Salzburg, Austria.

Correspondence to: Thomas Edrich, MD, Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02467; e-mail: tedrich@partners.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(5):e14-e16. doi:10.1378/chest.13-2140
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Extract

At an outside hospital, a 63-year-old man with severe COPD and a lung mass underwent a left upper lobectomy complicated by both a persistent air leak requiring chest tube placement and hospital-acquired pneumonia requiring reintubation. A DVT developed in the upper extremity, requiring full anticoagulation treatment. Subsequently, a spontaneous retroperitoneal hemorrhage occurred, as diagnosed by abdominal CT scan, requiring massive transfusion and reversal of heparin with protamine. During resuscitation, the patient developed a distended abdomen (bladder pressure of 23 mm Hg), oliguria, and hypotension requiring norepinephrine.

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Figures

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Video 1

Cardiac ultrasound with two-dimensional views

Video 2

Pleural ultrasound over the left anterior chest

Video 3

CUS examination of the proximal leg vessels

Discussion Video

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