CHEST Guidelines-A-61-Year-Old-Man-With-Respiratory-Failure-and-Sho

A-61-Year-Old-Man-With-Respiratory-Failure-and-Sho

Pdf Summary

A 61-year-old man with asthma, hepatitis C, and opioid use was admitted with lethargy and respiratory distress. He had recent upper respiratory symptoms, decreased intake, dark urine, and loose stools. Initial examination showed hypothermia, low oxygen saturation, high respiratory rate, and confusion, requiring intubation due to respiratory failure and mental status deterioration. His abdomen was distended, and lung auscultation revealed rales. Post-intubation, he experienced hypotension, necessitating vasopressors.<br /><br />Tests indicated influenza A infection, severe metabolic acidosis, acute renal failure, and liver failure. X-rays suggested possible subdiaphragmatic free air, but an abdominal CT was needed for confirmation. Ultrasound suggested pneumoperitoneum and ischemic bowel, findings later confirmed by CT showing free air and bowel pneumatosis. Due to the patient's complex medical condition and multiorgan failure, surgery was not viable, and he succumbed to septic shock and abdominal compartment syndrome.<br /><br />The case highlights the significance of abdominal ultrasound in detecting air and fluid artifacts, aiding early diagnosis of abdominal catastrophes. Ultrasound artifacts, like the "curtain sign", can obscure deep structures, necessitating CT confirmation. Understanding ultrasound physics is crucial for effective diagnostic use of point-of-care ultrasound (POCUS) and guiding clinical decisions. Proper interpretation of signs like absent gut sliding can suggest free air presence, reinforcing the role of clinical judgment in diagnosis and management. The case underscores POCUS's potential in expediting decisions by identifying conditions like pneumatosis intestinalis swiftly, ultimately verified by imaging.

Keywords

respiratory distress

influenza A

metabolic acidosis

renal failure

liver failure

ultrasound artifacts

pneumoperitoneum

abdominal compartment syndrome

point-of-care ultrasound

clinical judgment