Critical Care
The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
December 2015 Critical Care Case of the Month
Samir Sultan, DO
Banner University Medical Center Phoenix
Phoenix, AZ
History of Present Illness
The patient is a 32-year-old woman who presented with flank pain for 3 days to an outside hospital. She was diagnosed with pyelonephritis and begun on ceftriaxone. She was discharged against medical advice on cephalexin.
She returned to the same hospital 3 days later by ambulance with labored breathing and weakness and was emergently intubated. She was transferred for ventilator management and respiratory failure.
Past Medical History
She has a long history of poorly controlled diabetes mellitus.
Physical Examination
She is orally intubated and sedated.
Vitals: Temperature - 100.9º F, Blood Pressure - 117/75 mm Hg, Heart Rate - 148 beats per minute, Respiratory Rate - 31 breaths/min, SpO2 - 88 % on assist control of 30, tidal volume of 350 mL, PEEP 15, and an FiO2 100%.
There is scatted rhonchi and rales but the remainder of the physical examination is unremarkable.
Radiography
Her admission portable chest X-ray is shown in Figure 1.
Figure 1. Admission portable AP of the chest.
Which of the following should be ordered as part of her initial work-up? (Click on the correct answer to proceed to the second of five panels).
- Administer broad spectrum antibiotics
- Blood and urine cultures
- Rapid influenza test
- 1 and 3
- All of the above
Cite as: Sultan S. December critical care case of the month. Southwest J Pulm Crit Care. 2015;11(6):246-51. doi: http://dx.doi.org/10.13175/swjpcc147-15 PDF
Ultrasound for Critical Care Physicians: Cardiogenic Shock-This Is Not a Drill
Ramakrishna Chaikalam, MD
Shozab Ahmed, MD
Division of Pulmonary, Critical Care and Sleep
University of New Mexico
Albuquerque, NM
A 45-year-old woman with no significant past history developed gradual onset of shortness of breath and cough over 1 week. She presented to the emergency department. Her initial chest x-ray showed an enlarged heart and bilateral pulmonary edema. The patient became progressively hypotensive and hypoxic and was intubated. Transthoracic echocardiography is shown below (Figure 1).
Figure 1. Transthoracic echocardiogram in the para-sternal long axis view of the heart.
What intra-cardiac device in the left ventricle is pictured on the image? (Click on the correct answer to proceed to the next panel)
- Amplatz closure device of atrial septal defect
- Extracorporeal membrane oxygenator (ECMO) cannula
- Impella device
- Intra-aortic balloon pump
- Pacemaker lead
Reference as: Chaikalam R, Ahmed S. Ultrasound for critical care physicians: cardiogenic shock-this is not a drill. Southwest J Pulm Crit Care. 2014;9(1):27-9. doi: http://dx.doi.org/10.13175/swjpcc091-14 PDF