Compressed
Cardiovascular System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M43_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022...and get 1cc of epi!\u0022\n\nYou make your way up to the doctors\u0027 lounge after this morning\u0027s excitement in the Emergency Room.\n"}]}
1
{"ops":[{"insert":"You sink wearily into the threadbare couch with a cup of weak coffee and replay the case in your mind.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M43_F3.jpg"}},{"insert":"\n\n"},{"insert":"Mr. Charles, a 65-year-old retiree, was brought in by paramedics, with severe left sided chest pain and difficulty in breathing upon waking up this morning. He was accompanied by his wife Rita.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M43_F4.jpg"}},{"insert":"\n\n"},{"insert":"As Mr. Charles was rolled into the ER on a gurney, you asked Rita about his history.\n \n\u0022He\u0027s been coughing for about a month now, and even coughed up blood once, but no, he never hit his chest anywhere, and he hasn\u0027t been involved in an accident recently\u0022, she replied.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M43_F5.jpg"}},{"insert":"\n\n"},{"insert":"You scanned through his medical records and noted that he\u0027d had a liver transplant for end-stage liver disease following hepatocellular carcinoma a year ago and that he had been on immunosuppressants afterward (cyclosporine, azathioprine, and prednisolone), with no recent adverse events.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M43_F6.jpg"}},{"insert":"\n\n"},{"insert":"You quickly examined him and noted the following findings:\n\nTemperature: 97.7 \u02daF\nBP: 80\/50 mmHg\nPulse: 120 bpm\nRR: 42 cpm\n"}]}
6
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M43_F3.jpg"}},{"insert":"\n\n"},{"insert":"Cardiovascular examination revealed a distended jugular venous pulse and an absent apical impulse, while the heart sounds (1st and 2nd) were muffled and distant.\n \nBilateral basal crepitations were heard in the lung fields, with good air entry.\n"}]}
7
{"ops":[{"insert":"Abdominal examination was normal except for mild hepatomegaly which was tender and soft with a blunt edge.\n \nHe was conscious but drowsy, and could barely respond to your questions.\n"}]}
8
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M43_F9.jpg"}},{"insert":"\n\n"},{"insert":"The bedside EKG showed sinus tachycardia with low voltage QRS complexes.\n \nBased on your working diagnosis of cardiac tamponade, you realized the need to act swiftly ...\n"}]}
9
{"ops":[{"insert":"What did you do?\n"}]}
1. Perform an emergency pericardiectomy to relieve the tamponade
2. Perform an emergency echocardiography-guided para-apical pericardiocentesis
11
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14
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10
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12
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13
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