SCCM Resource Library-Case Presentation: Current Opinions in Shock Monitoring

Video Transcription

Video Summary

Dr. Saras Chandra Vallabha Josula, an interventional and critical care cardiologist, presented a case of a 71-year-old female with unresponsiveness and worsening symptoms over the past four days. The patient had swelling, blistering, erythema, and generalized edema on her legs. She had tachycardia, hypotension, and was not breathing well. Initial labs showed high potassium, acute kidney injury, and high B-type nitritic peptide. She was treated for septic shock with norepinephrine, broad spectrum antibiotics, and other medications. An echocardiogram showed biventricular decrease in function and moderate to severe mitral and tricuspid regurgitation. Coronary angiogram revealed a mid-LAD stenosis, which was revascularized. The patient initially responded well to treatment but suddenly worsened with declining urine output and peripheral vasodilation. Repeat echocardiogram showed worsening right ventricular involvement. The patient was placed on biventricular impeller support but continued to decline and eventually passed away. The case highlights the importance of considering alternate etiologies and taking a holistic approach to shock.

Asset Subtitle

Cardiovascular, Procedures, 2022

Asset Caption

Hemodynamics in patients with shock are often complex and can change rapidly as the course of disease evolves and as therapies are initiated. Close monitoring of patients with shock is clearly important, but precisely how to do this remains a subject of great controversy. Years ago, invasive hemodynamic monitoring was common and even routine in some settings, but over time less invasive options have evolved. It remains uncertain whether something has been lost in this shift.

Meta Tag

Content Type Presentation

Knowledge Area Cardiovascular

Knowledge Area Procedures

Knowledge Level Intermediate

Knowledge Level Advanced

Learning Pathway Cardiothoracic Critical Care

Membership Level Select

Tag Shock

Tag Monitoring

Tag Cardiothoracic Critical Care

Year 2022

Keywords

Dr. Saras Chandra Vallabha Josula

interventional and critical care cardiologist

septic shock

biventricular decrease in function

mid-LAD stenosis

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