Case 3 - Hypovolemic Shock - GI Bleed
Indication:
Shock Differentiation: Given the information from the scenario, the four classes of shock were potentially on the differential. The JVP would have been helpful though it was not visible which is not an uncommon situation.
With the hip surgery, pulmonary embolism resulting in obstructive shock and distributive shock from sepsis from nosocomical sources were the prime suspects.
Image Acquisition:
The subcostal view was difficult to image in this particular case though the parasternal views sufficed to answer the questions.
Shock Differentiation: Given the information from the scenario, the four classes of shock were potentially on the differential. The JVP would have been helpful though it was not visible which is not an uncommon situation.
With the hip surgery, pulmonary embolism resulting in obstructive shock and distributive shock from sepsis from nosocomical sources were the prime suspects.
Image Acquisition:
The subcostal view was difficult to image in this particular case though the parasternal views sufficed to answer the questions.
Interpretation:
The combination of collapsed IVC and hyperdyanmic LV are seen in both hypvolemic shock and distributive shock. The latter may have variable IVC findings depending on the subject's volume status.
Clinical Synthesis:
Given the patient extremities were not warm and the patient lack findings suggestive for an infection, hypovolemic shock was the working syndrome. Of note, other types of shock may coexist though hypovolemia was the most significant contributor at the time -- also, it would be the simplest to rectify. Hence, volume expansion aggressively infused.
The patient was found to have a significant upper gastrointestinal bleed due to celecoxib commencement post-operative for analgesia.
The combination of collapsed IVC and hyperdyanmic LV are seen in both hypvolemic shock and distributive shock. The latter may have variable IVC findings depending on the subject's volume status.
Clinical Synthesis:
Given the patient extremities were not warm and the patient lack findings suggestive for an infection, hypovolemic shock was the working syndrome. Of note, other types of shock may coexist though hypovolemia was the most significant contributor at the time -- also, it would be the simplest to rectify. Hence, volume expansion aggressively infused.
The patient was found to have a significant upper gastrointestinal bleed due to celecoxib commencement post-operative for analgesia.