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075 – The less appreciated ventricle – a discussion with Graeme.

Hypothetical case:

You are called to a code blue medical on the gynaecology ward. A patient in her late 60s has collapsed in the bathroom. You are told she was admitted earlier that day for investigation of a probable pelvic cancer. She is conscious, has a heart rate 130/min, NIBP 90/45, SPO2 94% on hudson mask, and is mildly SOB with a respiratory rate 30/min.

This patient undergoes investigation and is diagnosed with a large pulmonary embolism.

She deteriorates suddenly with the following vitals: groaning, HR 145/min, NIBP 60/35, SpO2 85%, Respiratory rate 35/min.

What is the physiology and what are the principles behind the resuscitation of a patient with an acute right ventricular emergency like this?

Fluids? Vasopressors? Inotropes? Thrombolysis? Intubation? Pulmonary vasodilators?

Join Graeme and I as we discuss this particularly challenging scenario which can be both hard to diagnose and resuscitate. There are some important and critical differences to other common causes of deterioration, and serious traps to be aware of and avoid.

Whilst educating myself on this topic I realised that I wasn’t as up to speed on this as I thought I was! Thanks to the following resources which I have listed below which I strongly recommend:

USEFUL LINKS

EMCrit 272 – Right Heart Failure with Sara Crager

PulmCrit- Nebulized nitroglycerin: The stealth pulmonary vasodilator hiding under your nose?

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