Abstract | March 15, 2023

Use of Point of Care Echocardiogram in Cardiogenic Shock and How It Can Change Management in the Emergency Department

Lauren Powell, DO

Co-authors: Lisa Bundy, MD, Emergency Medicine, Attending Physician, Magnolia Regional Health Center, Corinth, MS.

Learning Objectives

  1. Describe how point of care echocardiogram can change management in the emergency department
  2. Discuss how proficiency and efficiency in point of care ultrasound can impact patient care in the emergency department

Shock is commonly seen in the emergency department and the ability to quickly determine what kind of shock can be lifesaving in the emergency department (ED). Patients in cardiogenic shock need different treatment than patients with other types of shock. Being able to use bedside echocardiogram to rule in or rule out cardiogenic shock can change management, especially in a rural ED.

Case Presentation: A 53 y/o female, status post mitral valve replacement, presents to ED complaining of dyspnea and chest pain. EMS found the patient with altered mentation and cold, clammy skin. When EMS arrived, they were unable to find a blood pressure. Patient arrived in shock and respiratory failure. On exam, patient is lethargic in respiratory distress with altered mental status. Patient has bilateral 3+ pitting edema to the level of the knees. Her skin is cool and clammy with mottling noted in feet bilaterally. Initial labs showed a potassium of 8.7, creatinine of 4.4, and a BUN of 53. ABG shows a pH of 7.106, PCO2 of 72, PO2 of 10, and a HCO3 of 22.9. A bedside 2D echocardiogram was performed. The parasternal long axis showed an increased EPSS and global hypokinesis with a severely decreased ejection fraction (EF) of 20%. The apical four chamber showed dilated right atrium and right ventricle. IVC views showed a plethoric IVC with increased pressures in the hepatic vein.

Diagnosis: Cardiogenic Shock Management:

Initially, the patient came in for undifferentiated shock with IV fluids running by EMS. When the bedside echocardiogram revealed cardiogenic shock within minutes of arrival, IV fluids were stopped, and Levophed and dobutamine were started. By using bedside ultrasound, undifferentiated shock was appropriately diagnosed and this patient’s management was geared toward her specific needs. Levophed was initiated due to hypotension, and dobutamine was added for the ionotropic effects to treat cardiogenic shock. The patient was accepted for transfer at the hospital that performed her procedure. Prior to transfer, the patient’s color improved and she had a systolic blood pressure in the 130s.



Back to Abstracts