Nieves Lopez Laguna, Raquel Piñero Panadero, Elena Refoyo Salicio, Manuel García De Yebenes Castro, Aitor Hernández Hernández, Sandra Jahnke, Maria García-Uría Santos

AIM

To evaluate the utility of the point of care ultrasound to detect the cause of hemodynamic instability in critical patients

CASE REPORT

A 73 years old man, smoker, with a personal history of arterial hypertension and liver transplantation because of a hepatocellular carcinoma on chronic hepatitis B, came to the Emergency Department complaining for weakness, progressive dyspnea, lightheadedness, cough and decreased level of consciousness Physical examination revealed low blood pressure, jugular venous distension, and pericardial rub The cardiopulmonary auscultation revealed quiet heart sounds.

A differential diagnosis was made between acute pulmonary edema, a tension pneumothorax, acute heart failure and cardiac tamponade.

The electrocardiogram showed a sinus rhythm with low voltage.

We decided to perform a bedside echocardiography evaluation where we found an uncontrolled pericardial effusion. We got in touch with Cardiology Department that performed a pericardiocentesis.

RESULTS

Transthoracic echocardiography can identify the great majority of cardiac causes of shock and help us to give an immediate hemodynamic support

CONCLUSIONS

In a critically ill patient the early etiological diagnosis is mandatory for the situation management and therefore of survival.