Should We Stop Trending Lactate in Septic Shock? ANDROMEDA-SHOCK Published
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Jon-Emile S. Kenny MD [@heart_lung] “The truth is balance, but the opposite of truth, which is unbalance, may not be a lie.” -Susan Sontag Case A 49 year old man presents with two days of hemoptysis, right-sided pleuritic chest pain and a few hours of ‘confusion’ according to his teammate in a pick-up hockey league. One week prior, he had experienced respiratory symptoms and myalgias with fever, but he improved over 5 days. He has no known medical history and takes no medicine. On presentation, the patient’s heart rate is regular at 155 beats per minute; his saturation without supplemental oxygen is 84% and he is with notable tachypnea. His blood pressure is 82/29 mmHg. He is warm to the touch with rapid capillary refill noted by the medical student. The patient’s CXR demonstrates a right lower lobe cavity with surrounding infiltrate and large effusion and his blood work is notable for acute kidney injury, leukocytosis and a venous lactate of 7.0 mmol/L; the resident in the emergency department starts the patient on high-flow nasal cannula, immediately orders linezolid and places a right-sided subclavian triple lumen catheter. The patient’s CVP is 6 mmHg.
Should We Stop Trending Lactate in Septic Shock? ANDROMEDA-SHOCK Published
Should We Stop Trending Lactate in Septic…
Should We Stop Trending Lactate in Septic Shock? ANDROMEDA-SHOCK Published
Jon-Emile S. Kenny MD [@heart_lung] “The truth is balance, but the opposite of truth, which is unbalance, may not be a lie.” -Susan Sontag Case A 49 year old man presents with two days of hemoptysis, right-sided pleuritic chest pain and a few hours of ‘confusion’ according to his teammate in a pick-up hockey league. One week prior, he had experienced respiratory symptoms and myalgias with fever, but he improved over 5 days. He has no known medical history and takes no medicine. On presentation, the patient’s heart rate is regular at 155 beats per minute; his saturation without supplemental oxygen is 84% and he is with notable tachypnea. His blood pressure is 82/29 mmHg. He is warm to the touch with rapid capillary refill noted by the medical student. The patient’s CXR demonstrates a right lower lobe cavity with surrounding infiltrate and large effusion and his blood work is notable for acute kidney injury, leukocytosis and a venous lactate of 7.0 mmol/L; the resident in the emergency department starts the patient on high-flow nasal cannula, immediately orders linezolid and places a right-sided subclavian triple lumen catheter. The patient’s CVP is 6 mmHg.