An 83-year-old patient underwent surgery for empyema of metatarsophalangeal joint five days ago. The postoperative period was without any signs of complication, no sepsis developed. She was admitted to ICU for worsening dyspnea. Hypervolemia with retention of fluid was diagnosed. Significant fluidothorax developed bilaterally. The patient had had no history of cardiac problems so far. …
A patient underwent laparotomy for ileus one day ago. She required a gradual increase of the noradrenaline dose along with an increasing level of lactate during the night. She had pulmonary embolism two months ago. Bedside echocardiography was performed:
A 45-year-old woman with a history of type-II diabetes (peroral antidiabetics) underwent surgery for splenic abscess. Splenectomy was performed without any complication. The patient was transferred to the standard ward after surgery. Histology confirmed abscess; however, infected intraparenchymal haematoma could not be excluded. Cultivation revealed Propionibacter avidum (typical skin flora commensal). The patient reported therapy …
An 82-year-old patient underwent elective surgery (right hemicolectomy) due to the adenocarcinoma of the ascending colon. On the 5th day, the patient vomited intestinal content. She was admitted to the ICU for respiratory insufficiency several hours later. The patient had to be intubated (after short non-invasive ventilation). Shock developed during mechanical ventilation and levels of …
Pericardial effusion is usually revealed with use of subcostal scanning plane. The fluid is usually localised dorsally and caudally due to gravitational force. Pericardial effusion often mounts on diaphragm and liver in a patient in the semi-sitting position. It may be challenging to visualise central fibrous part of the diaphragm since it is thin at …
Examination of inferior vena cava is useful in conditions with borderline intravascular amount of fluid – either significant deficit or excess. Proper detection of inferior vena cava may be difficult in case of its collapse. It can often be mixed up with aorta, which would result in a completely wrong assessment of the fluid amount. …
Sometimes it is challenging to decide whether to administer fluid or not. Following case shows one of these difficult situations: A 70-year-old patient underwent laparotomy for intestinal ischemia. Approximately 15 cm of ileum had to be resected for necrosis and perforation of Meckel´s diverticulum. Embolectomy from the peripheral part of the superior mesenteric artery was …
An 80-year-old patient underwent abdominal surgery (part of the small intestine was resected due to ischemia). Dyspnea developed on the 3rd day after extubation. Tachypnea with RR of about 30/minute. Physiological blood gas exchange. No antibiotic therapy. Lab tests revealed decreasing levels of inflammatory markers. No metabolic acidosis was present. We started looking for the …
An 82-year-old patient underwent surgery for big retrosternal goitre. The jugular approach was used. Patient´s medical history had been minimal so far. Bleeding into surgical wound occurred shortly after surgery. Prompt re-intubation and surgical revision were necessary. A short period of haemodynamic instability occurred during surgical revision. Blood loss of 500 ml was compensated via …
An 86-year-old patient underwent total hip replacement one day ago. She was conscious, well-oriented to time and space. She was breathing spontaneously without the necessity of oxygen therapy. Sinus rhythm. Hypotension (90/42 mmHg, mean arterial pressure 59 mmHg), without the need of administration of catecholamines. A stable level of haemoglobin, physiological capillary refill time, the …
