So last night, an interesting call from the ED about a 50 year old man who presented with a 3 week history of increasing dyspnea, leg edema, temp of 39, a lactate of 3.9, an INR of 1.7, elevated LFTs and a WBC of 18, but a BP of 130/75.
Fortunately, I was dealing with a saavy ER doc with some POCUS capabilities, so he also told me he saw a pretty big IVC and he was a bit leery about giving fluids, though this looked like pretty severe sepsis with 3 or 4 affected organ systems…
So I asked him to hold fluids until I got there. Here is what POCUS found:
He revealed a past history of untreated hypertention, and a flu-like illness 3-4weeks ago.
What’s the diagnosis (-es) and management?
Answers & Clinical evolution in part 2 tomorrow!
cheers
Philippe
thinking critical care 
Looks like severe LV function impairment, apical LV thrombus, MR, pulmonary edema.
Acute heart failure due to myocarditis?
Requires anticoagulation, inotropes, possibly Cpap, cardiology/cardiac surgery consultation
Clinically sounds like he is in cardiac failure with some infectious element going on.
Distended IVC with essentially no variation with respiratory cycle. Lots of B lines in the lungs. LV function looks markedly reduced with what looks like a big thrombus inside? Biochemical hepatitis could be from cardiac failure.
Possibly myocarditis of some cause, probably infectious given recent flu like illness?
Is tehre pleural effusion along with B lines,LV Thrombus and decreased contactility?
You got it!