The study coming out in Annals of Emergency Medicine in June done by Haydar et al “found point-of-care ultrasonographic data about cardiac contractility, inferior vena cava diameter, and inferior vena cava collapsibility to be clinically useful in treating adult patients with sepsis” – for those of us who use US regularly to evaluate patients in shock, whether it’s by using the RUSH protocol or evaluating the initial and post-fluid volume status for those we are trying to resuscitate when septic, it’s no big surprise. What is the surprising aspect of this is that 53% of septic patients’ treatment plans had changed due to the findings by ultrasound of cardiac contractility and IVC appearance. That is higher than I expected. Although the power of the study was low, it is definitely worth appreciating this outcome. other results include physicians altered the presumed primary cause of vital sign abnormalities in 17%. They also evaluated the certainty of the physician in their decision making after ultrasound – which increased in 71% of cases.
SonoCase: I’ll never forget the case I had of an elderly patient with end stage renal disease who was post renal transplant (making urine) the month earlier with fever, tachycardia and SBP in the 80s, shockingly feeling pretty weak. I thought of the usual – supplemental O2, IVF starting with 2 Liter NS bolus (then re-eval – classically by listening to the lungs, now by visualization of the IVC) with monitor, labs, lactate and blood/Ur cx. But, I took a look at his IVC first and saw this:
So, I reconsidered….. gave pressors…. and definitely thought of stress-dose steroids.
Look out tomorrow for a review of IVC ultrasound…