0
ONLINE EXCLUSIVES
Ultrasound Corner |

A 72-Year-Old Man Presenting With Melena and Multiple Falls Becomes Acutely DecompensatedMan With Melena Becomes Acutely Decompensated

Ryu Tofts, MD; Pierre Kory, MD; Samuel Acquah, MD
Author and Funding Information

From Mount Sinai Beth Israel Hospital, Pulmonary Critical Care, New York, NY.

CORRESPONDENCE TO: Ryu Tofts, MD, Mount Sinai Beth Israel Hospital, Pulmonary Critical Care, 1st Ave at 16th St, 7 Dazian Building, New York, NY, 10003; e-mail: rtofts@doctors.org.uk


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


Chest. 2014;146(4):e130-e133. doi:10.1378/chest.13-1822
Text Size: A A A
Published online

Extract

A 72-year-old man was brought to the ED after passing melena for 1 day and multiple falls. The patient had recently undergone a lobectomy for non-small cell lung cancer and was recovering in a rehabilitation facility. He had a history of ischemic stroke and was taking an oral direct thrombin inhibitor. At presentation, he was conversant and hemodynamically stable, his hemoglobin level was 4.4 g/dL, international normalized ratio was 4.4, and lactate level was 2.1 mmol/L. IV access was obtained, and a Foley catheter was inserted. A nasogastric tube was placed and revealed scant coffee-ground drainage. Treatment was started with continuous infusion of IV proton pump inhibitors, and the patient received one unit of packed RBCs and two units of fresh frozen plasma. Shortly thereafter, the patient became diaphoretic, unresponsive, and tachypneic, and he demonstrated diffuse abdominal tenderness. He was intubated for airway protection. Examination revealed pallor, anuria, clear breath sounds, and a rigid abdomen. Repeated testing revealed his lactate level was elevated to 8 mmol/L, and hemoglobin level was 3.5 g/dL. A focused assessment with sonography for trauma (FAST) examination was performed to evaluate the abdominal findings and to search for a focus of bleeding. The ultrasound findings are shown in Videos 1-3.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

Video 1

Epigastrium to suprapubic space

Running Time: 0:11

Video 2

Suprapubic space

Running Time: 0:09

Video 3

Right upper quadrant

Running Time: 0:15

Discussion Video

Discussion video

Discussion Video 4

well-demarcated anechoic space

Discussion Video 5

well-demarcated anechoic space

Discussion Video 6

Right upper quadrant

Discussion Video 7

Ultrasound images in the four positions

Discussion Video 8

Left lower quadrant

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543