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Case Studies 012 Presenting With Hypotension What's The

The document presents a fictional medical case of a 71-year-old male with a history of coronary artery disease and mitral regurgitation, who is experiencing weakness after recent heart surgery. The physical examination suggests possible cardiac tamponade, confirmed by ultrasound showing a large pericardial effusion. The recommended treatment includes cautious fluid management, dobutamine, and potential pericardiocentesis or surgery for the effusion.

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Ibsa Abdo
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33 views12 pages

Case Studies 012 Presenting With Hypotension What's The

The document presents a fictional medical case of a 71-year-old male with a history of coronary artery disease and mitral regurgitation, who is experiencing weakness after recent heart surgery. The physical examination suggests possible cardiac tamponade, confirmed by ultrasound showing a large pericardial effusion. The recommended treatment includes cautious fluid management, dobutamine, and potential pericardiocentesis or surgery for the effusion.

Uploaded by

Ibsa Abdo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MEDICAL DISCLAIMER

Medical Disclaimer: The cases presented


here are fictional. These are referenced
and created by Ninja Nerd Inc. and are
meant for educational purposes only. This
is not meant to diagnose or treat medical
conditions.
SUBJECTIVE
HPI:

❏ 71 year old male with a PMH of CAD and Mitral


regurgitation presents to the ninja nerd clinic feeling
very weak. One week ago, he underwent a 2-vessel CABG and
mitral valve replacement with mechanical valve. Pt denies
N/V/D, cough, dysuria, urinary frequency, abdominal pain
or fever.
Physical exam?
❏ Vitals:
❏ HR: 130 RR: 22 BP:85/65 Temp: 101.4 F
SPO2: 92%
❏ Cardiovascular: tachycardic, regular rhythm,
JVD+,Decreased heart sounds, variation in
pulse of 12 mmhg during inspiration
❏ Pulmonary:Tachypneic, crackles B/L, SOB when
lying flat
❏ Abdominal:soft, non-tender to palpation, BS+
❏
Whats your suspected diagnosis?
❏ Tension Pneumothorax
❏ Massive Pulmonary embolism
❏ Cardiac tamponade
❏ NSTEMI/STEMI
❏ Decompensated Heart failure

❏
What Tests should i do first?
❏ Tension PTX
❏ Massive Pulmonary embolism
❏ Cardiac Tamponade
❏ NSTEMI/STEMI
❏ Decompensated Heart Failure

❏ Tests:
❏ 12 Lead ECG and Troponins
❏ CXR
❏ POC Ultrasound
ECG results? Trops:0.12-->0.15-->0.13
CXR results?
❏ Cardiomegaly
❏ Pulmonary edema
R>L
❏ No pneumothorax
POC U/S results?
❏ Large
pericardial
effusion
causing cardiac
Tamponade
❏ No Pneumothorax
What's our diagnosis?
● Cardiac tamponade likely
2/2 Recent CABG and
Mitral Valve replacement
What’s the treatment?
Emergent Treatment?
1. Hypotension
a. IVF cautiously and Dobutamine +/-
Vasopressors
2. Cardiac Tamponade
a. Pericardiocentesis
b. Pericardiotomy vs Pericardiectomy
if high risk of recurrence or
failure of pericardiocentesis
Q&A

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