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Critical Care Echo Rounds

Haemodynamic instability

Echo Research & Practice volume 1, pages D1–D8 (2014)Cite this article

Abstract

The use of echocardiography, whilst well established in cardiology, is a relatively new concept in critical care medicine. However, in recent years echocardiography’s potential as both a diagnostic tool and a form of advanced monitoring in the critically ill patient has been increasingly recognised. In this series of Critical Care Echo Rounds, we explore the role of echocardiography in critical illness, beginning here with haemodynamic instability. We discuss the pathophysiology of the shock state, the techniques available to manage haemodynamic compromise, and the unique role which echocardiography plays in this complex process.

Case

A 69-year-old female presents to the emergency department with a fever, confusion and pain on urinating. Her blood pressure on arrival was 70/40, with heart rate of 117-bpm Despite 3-l of i.v. fluid she remained hypotensive. A central venous catheter was inserted and noradrenaline infusion commenced, and she was admitted to the intensive care unit for management of her shock state. At 6-h post admission, she was on high dose of noradrenaline (0.7-μg/kg per min) but blood pressure remained problematic. An echocardiogram was requested to better determine her haemodynamic state.

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Authors and Affiliations

  1. Critical Care Department, Faculty of Medicine, Alexandria University, Alazarita, Alexandria, Egypt

    Ashraf Roshdy MBBch MSc MD MRCP

  2. Imperial College London, National Heart and Lung Institute (NHLI), London, UK

    Ashraf Roshdy MBBch MSc MD MRCP & Nadia Francisco MSc

  3. University College of London Hospitals, London, UK

    Alejandro Rendon MSc & David Walker MRCP FRCA FFICM

  4. Critical Care Unit, King’s College Hospital, London, UK

    Stuart Gillon MbChB MRCP FFICM PGDip

Authors
  1. Ashraf Roshdy MBBch MSc MD MRCP
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  2. Nadia Francisco MSc
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  3. Alejandro Rendon MSc
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  4. Stuart Gillon MbChB MRCP FFICM PGDip
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  5. David Walker MRCP FRCA FFICM
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Corresponding author

Correspondence to Ashraf Roshdy MBBch MSc MD MRCP.

Additional information

PGDip in Perioperative and Critical Care Echocardiography

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://doi.org/creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Roshdy, A., Francisco, N., Rendon, A. et al. Critical Care Echo Rounds. Echo Res Pract 1, D1–D8 (2014). https://doi.org/10.1530/ERP-14-0008

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  • DOI: https://doi.org/10.1530/ERP-14-0008

Echo Research & Practice

ISSN: 2055-0464

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