{"id":753,"date":"2017-08-19T02:31:02","date_gmt":"2017-08-19T02:31:02","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=753"},"modified":"2020-07-22T00:09:38","modified_gmt":"2020-07-22T00:09:38","slug":"case-4-to-bolus-or-not-to-bolus","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/19\/case-4-to-bolus-or-not-to-bolus\/","title":{"rendered":"Case # 4: To Bolus or Not to Bolus?"},"content":{"rendered":"
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A 67 year old male with a PMHx of DM presents with a chief complaint of cough and generalized weakness.<\/p>\n

Vitals: T 102.4 HR\u00a0127\u00a0BP\u00a077\/58\u00a0\u00a0RR\u00a024\u00a0O2\u00a088% on RA<\/p>\n

You place the patient on O2 via nasal cannula and activate the sepsis protocol. He is empirically treated with broad spectrum antibiotics and IVFs are started. The chest x-ray shows multifocal pneumonia and you call hospital medicine to admit the patient.\u00a0 \u201cWhat\u2019s the blood pressure now,\u201d the hospitalist asks. You glance at the monitor and murmur back, \u201c92\/63, but he looks pretty good.\u201d The hospitalist asks you to insert a central line, start vasopressors, and contact the ICU. Instead, you wheel the ultrasound machine into his room, and ultrasound his IVC. Does this patient require a central line and vasopressors?<\/p>\n<\/div>\n<\/div>\n<\/div>\n

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Long Axis View of IVC<\/p><\/div>

\"M-mode:<\/a>

M-mode: IVC collapse with respiratory variation<\/p><\/div><\/div><\/div>\n<\/div>\n<\/div>\n

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Answer and Learning Point<\/h3>
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Answer<\/strong><\/p>\n

No, the patient\u2019s IVC is small and collapsing almost 75% with normal respiratory variation. This predicts a fluid-responsive state. The patient was given another liter of lactated ringers, his blood pressure improved to 108\/69, and his lactate cleared. You start maintenance IV fluids, call the hospitalist back, and the patient is admitted upstairs and does well.<\/span><\/p>\n

Learning Points<\/strong><\/p>\n