SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock
Article Category: Case report
Published Online: Nov 27, 2019
Page range: 149 - 156
Received: May 31, 2019
Accepted: Sep 23, 2019
DOI: https://doi.org/10.2478/jccm-2019-0022
Keywords
© 2019 Yingke He, John Ong, Thuan Tong Tan, Brian K. P. Goh, Sharon G. K. Ong, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
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Bedside Point of Care Ultrasound (POCUS) examination findings by systems to evaluate the aetiology of shock
| SYSTEMS | SHOCK | |||
|---|---|---|---|---|
| Hypovolemic Shock | Cardiogenic Shock | Distributive Shock | Obstructive Shock | |
| Cardiovascular Findings | Hypercontractile heart with small Left Ventricle chamber size | Hypocontractile heart with dilated Left Ventricle | Hypercontractile heart in early sepsis Hypocontractile heart in late sepsis | Cardiac Tamponade - Presence of pericardial fluid - Right ventricle collapse during diastole Presence of Cardiac Thrombus Right Ventricle Dysfunction (Pulmonary Embolism) - Hypocontractile RV with dilatation - Moderate to severe tricuspid regurgitation - McConnell’s sign (reduced right ventricular free wall motion but reserved apical motion) -D shaped ventricle with abnormal motion in interventricular septum |
| Respiratory Findings | Hemothorax - Presence of ho- mogeneous echoic effusion/Hematocrit Sign | Pulmonary edema - Lung rockets with multiple diffuse B lines Pleural Effusion - Presence of free pleural fluid | Pneumonia - Presence of Air bronchogram - Loss of A lines - Presence of patchy B lines - Pleural effusion with/with- out multiple septations | Tension Pneumothorax - Absence of normal lung sliding - Absence of seashore sign on M mode - Presence of barcode sign on M mode |
| Abdominal and Other Findings | Collapsed Inferior Vena Cava (< l2mm) Ruptured/Leaking Abdominal Aortic Aneursym - Focal aortic dilatation - Peri-aortic fluid, free intraperitoneal fluid, retroperitoneal fluid Aortic dissection - Presence of aortic root dilatation and intimal flap on the Parasternal Long Axis or longitudinal views (transthoracic or transabdominal) | Distended Inferior Vena Cava (> 20mm) | Collapsed Inferior Vena Cava (<12mm) Peritonitis - Presence of peritoneal fluid with/without septation Pyelonephritis - Swollen kidney with increased anechoic corticomedullary area Cholecystitis - Presence of cholelithiasis - Sonographic Murphy sign - Gallbladder wall thickening (>3mm) and presence of pericholecystic fluid Cholangitis - Common bile duct dilatation - Thickening of wall of bile ducts - Presence of debris in the common bile ducts (pus or sludge) | Distended Inferior Vena Cava (> 20mm) Presence of Lower Limb Deep Vein Thrombosis |