Echocardiography Does Not Correlate with Volume Status says CoDE-MiN Study
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Jon-Emile S. Kenny MD [@heart_lung] “Nolite te bastardes carborundorum” -Margaret Atwood Case An 86 year old woman presents with two days of decreased intake by mouth and 3 days of melena and vomiting. She is followed closely by her internist and cardiologist for hypertension, severe mitral regurgitation, pulmonary venous hypertension and right ventricular dysfunction with co-morbid atrial fibrillation. She normally takes an ACE inhibitor, beta-blocker, warfarin and a statin as an outpatient. One week prior to her presentation, she experienced generalized muscle aches after a long day of gardening and treated herself with acetaminophen; her presenting INR is 5.7. In the ED, the patient is in rapid atrial fibrillation at 113 beats per minute and has a blood pressure of 115/40. The admitting resident is worried about transfusing the patient given her known cardiac co-morbidities so he performs point of care ultrasound. On examination, the patient’s inferior vena cava is large and unvarying. He withholds blood transfusion and calls his ICU fellow for assistance.
Echocardiography Does Not Correlate with Volume Status says CoDE-MiN Study
Echocardiography Does Not Correlate with…
Echocardiography Does Not Correlate with Volume Status says CoDE-MiN Study
Jon-Emile S. Kenny MD [@heart_lung] “Nolite te bastardes carborundorum” -Margaret Atwood Case An 86 year old woman presents with two days of decreased intake by mouth and 3 days of melena and vomiting. She is followed closely by her internist and cardiologist for hypertension, severe mitral regurgitation, pulmonary venous hypertension and right ventricular dysfunction with co-morbid atrial fibrillation. She normally takes an ACE inhibitor, beta-blocker, warfarin and a statin as an outpatient. One week prior to her presentation, she experienced generalized muscle aches after a long day of gardening and treated herself with acetaminophen; her presenting INR is 5.7. In the ED, the patient is in rapid atrial fibrillation at 113 beats per minute and has a blood pressure of 115/40. The admitting resident is worried about transfusing the patient given her known cardiac co-morbidities so he performs point of care ultrasound. On examination, the patient’s inferior vena cava is large and unvarying. He withholds blood transfusion and calls his ICU fellow for assistance.