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Case report
Use of point-of-care ultrasound in the management of patients presenting with shock: the treatment implications of an early bedside diagnosis of pulmonary embolism
  1. Fiqry Fadhlillah1 and
  2. Maiyuran Ratneswaran2
  1. 1Intensive Care, Whittington Health NHS Trust, London, UK
  2. 2Accident and Emergency, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Fiqry Fadhlillah; fiqry.fadhlillah{at}nhs.net

Abstract

Point-of-care ultrasound has been used to identify real-time indicators of acute obstruction to right ventricular outflow and aid appropriate diagnosis and management of patients presenting with extensive pulmonary embolism in whom haemodynamic instability permits only bedside investigation. We present the case of a 70-year-old woman who presented with shock. A focused bedside echocardiography was performed and showed left ventricular septal wall flattening and a severely dilated right ventricle with impaired systolic function. The right atrium was dilated with a floating thrombus visible on the sub-xiphoid view. The patient was treated with intravenous systemic thrombolysis (alteplase) prior to undergoing CT pulmonary angiogram. This showed saddle pulmonary embolus, with extensive thrombus in the main and all lobar pulmonary arteries bilaterally, with evidence of right heart strain.

  • pulmonary embolism
  • resuscitation
  • emergency medicine
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Footnotes

  • Contributors FF and MR were involved in management of the patient and the subsequent writing of the manuscript. Conception, planning and design of the manuscript was done by FF. MR performed the literature work and drafted the manuscript, which was then reviewed by FF.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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