multi-alphabet disease, sob, and tachycardic

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An 80s F presents to the ED with shortness of breath x one day.  There is no cough or chest pain.  Her medical problems include asthma-copd, cabg-mi-chf, dvt, and diabetes.  Her VS are HR 148, RR 28, BP 104/70, T 98.0.  Her room air oxygen sat is 80.  On exam, the patient is not in distress.  She has mild bibasilar crackles on exam, no S3, no murmurs, no JVD, and no lower extremity edema.  A cxr and an ekg are done.  What do we do next?

ekg cxra

One Comment

  • Tonynap

    no jvd wet lungs points to ARDS and/or pulmonary process. skin warm? cold? capillary refill?

    For all those reading…..
    JVD wet lungs= we all know what that equals

    JVD with clear lungs= massive PE, IWMI with RVI, Cor pulmonale (COPD) old or new, cardiac tamponade tension pneumo (always look at the trachea the same time you look at the neck). the key is to think of obstructive shock.

    no jvd, clear lungs=hypovolemia whatever source, distributive if skin warm

    *Note for all of these now would be a good time to fire up the ultrasound machine…..both to diagnose and to initially figure out fluid responsiveness

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