CASE STUDY: Contributed by Paul Boucher,
MD,
Foothills Medical Center, Calgary, Alberta
Clinical question: patient's cardiac function & source of the hypotension were unknown
32 year old male admitted following a crack cocaine overdose complicated by rhabdomyolysis,
acute renal failure, and presumed sepsis
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Levophed® was started after intubation to support his systemic blood pressure, and he was maintained on nitroglycerin for vital organ perfusion.
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On arrival at FMC, Patient was hyptotensive (79/56) and BP was difficult to support despite volume administration and increasing doses of Levophed.
Due to hypotension, patient was not sedated prior to placement of ClariTEE probe. ClariTEE probe was placed without any difficulties.
Clinical answer: ClariTee probe showed that the heart was underfilled and the right and left ventricles were not contracting properly
Day 1: initial images
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The LV is underfilled and exhibits
regional wall motion abnormality.
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RV dysfunction is present.
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Fluid administration is increased.
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Nitroglycerin is continued and
Levophed is titrated overnight.
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BP started to improve.
Day 2: morning
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Patient is hemodynamically optimized.
HR 104 BP 145/70 CVP 13.
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Heart adequately filled; left and
right-sided pumping function improved.
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Levophed is discontinued.
Levophed is a registered trademark of Hospira Inc.
