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Sudden Hypotension in a Medical PatientSudden Hypotension in a Medical Patient

Scott J. Millington, MD; Robert T. Arntfield, MD, FCCP
Author and Funding Information

From the Department of Critical Care Medicine (Dr Millington), The Ottawa Hospital/University of Ottawa, Ottawa; and Division of Critical Care Medicine (Dr Arntfield), University of Western Ontario, London, ON, Canada.

CORRESPONDENCE TO: Scott J. Millington, MD, Department of Critical Care Medicine, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada; e-mail: smillington@toh.on.ca


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


Chest. 2014;146(3):e78-e80. doi:10.1378/chest.13-2977
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Extract

A woman in her 80s with hypertension and dyslipidemia was seen in the ED complaining of progressive dyspnea for 3 days. She was found to be tachypneic and hypoxemic and was admitted to the internal medicine service with a provisional diagnosis of heart failure. A thoracic CT scan revealed small bilateral pleural effusions, a small pericardial effusion, and no evidence of pulmonary embolism (PE). She was treated with diuretics and afterload reduction.

On hospital day 5, the patient complained of suddenly feeling generally unwell and was found to be hypotensive (systolic BP, 70 mm Hg). Her heart rate, respiratory rate, temperature, and oxygen saturation levels were normal. On further history taking, she admitted to a sensation of chest heaviness with no other features of typical angina. Her ECG revealed ST elevations, which were diffuse but most prominent in the lateral leads (V3-V6). Her physical examination was noncontributory. The hospital’s Rapid Assessment of Critical Events (RACE) team was called, and the patient was treated with acetylsalicylic acid po and a bolus of IV normal saline. Upon arrival, the RACE team performed a point-of-care ultrasound examination using a portable device (Videos 1-4).

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Videos 1-4

Point-of-care ultrasound using portable device.

Discussion Video

Discussion Video

Video 1-7

Ultrasound used to diagnose a type A aortic dissection

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