S2D: The Symptom to Diagnosis Podcast Hypotension
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Feb 24, 2021 Explore a gripping case of an 18-year-old woman with severe hypotension as experts dissect her unusual staphylococcal bacteremia. Learn about crucial initial management steps, including how to define and treat different types of shock. Discover the subtle signs of central line infections and the misconceptions around sepsis. Dive into clinical pearls on antibiotic choices and the role of lactate in patient assessment. This insightful discussion is packed with diagnostic tips for anyone eager to sharpen their clinical skills.
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Think Tamponade After Cardiothoracic Surgery
- Not all postoperative hypotension after infection is ongoing sepsis; surgical bleeding into the pericardium can cause tamponade.
- Bedside echo revealed the tamponade after fluids and sepsis therapy failed to improve her.
Do Orthostatic Vitals For Suspected Volume Loss
- Always perform orthostatic vitals; a pulse rise >30 on standing strongly suggests large-volume loss.
- Use orthostasis to detect occult hypovolemia that may be missed when supine.
JVD Strongly Points To Cardiogenic Shock
- Jugular venous distension has a high positive likelihood ratio (≈11) for fluid overload and cardiogenic shock.
- Cool extremities plus JVD in a hypotensive patient strongly points to cardiogenic shock.
