Jon-Emile S. Kenny [@heart_lung] A 58 year old man with ethanol-related cirrhosis is admitted to the floor with anuria and a rising creatinine. Over the day, serial ultrasounds of his inferior vena cava [IVC] consistently reveal that it is diminutive and collapsing. He receives many liters of crystalloid without much change in his urine output. In the middle of the night, a rapid-response is called for dyspnea and desaturation with a lung ultrasound revealing bilateral and ubiquitous B-lines; he is placed on non-invasive positive pressure ventilation and given IV furosemide, but his blood pressure continues to fall. Repeat ultrasonographic assessment of his IVC reveals, again, a small and collapsible great vein; the overnight resident reaches for another liter of normal saline.
That Fallible IVC
That Fallible IVC
That Fallible IVC
Jon-Emile S. Kenny [@heart_lung] A 58 year old man with ethanol-related cirrhosis is admitted to the floor with anuria and a rising creatinine. Over the day, serial ultrasounds of his inferior vena cava [IVC] consistently reveal that it is diminutive and collapsing. He receives many liters of crystalloid without much change in his urine output. In the middle of the night, a rapid-response is called for dyspnea and desaturation with a lung ultrasound revealing bilateral and ubiquitous B-lines; he is placed on non-invasive positive pressure ventilation and given IV furosemide, but his blood pressure continues to fall. Repeat ultrasonographic assessment of his IVC reveals, again, a small and collapsible great vein; the overnight resident reaches for another liter of normal saline.