Hypotension & Retention
UnFiNiShEd CaSe CoMe BaCk LaTeR
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History of Present Illness:
A 62-year-old female on Coumadin for a-fib presents to the ED for near syncope and urinary retention. She had a cardiac cath 2 days prior. She hasn’t been able to pee more than drops since last night and feels like she has to. She denies or other complaints
Vital Signs & Physical Exam:
Vital signs are normal except for BP of 77/49. Physical exam is notable for suprpubic swelling and tenderness. It is otherwise normal with no visible hematomas.
Initial Differential Diagnosis: Urosepsis
Initial Diagnostic Testing:
- Foley: minimal urine
- Labs: none ordered
- Imaging: see bedside US below
QUESTIONS:
- What does the case image show?
- What should you do next?
- Want a 1-minute consult/tutorial on this case?
- Want to know what happened with this patient?
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ANSWERS:
- What does the case image show? The image shows the longitudinal view of a pelvic hematoma. At the top of the screen is the rectus abdominus and just behind that the less echoic hematoma and behind that more hyperechoic structures.
- What should you do next? Type and cross, get an INR (it was 3.8). Reverse the coumadin. Get a CT (images below show multiple hematomas and no distended bladder. The small white circle is the Foley. The other white areas are active bleeding). Consult cardiology, general surgery and IR.
- Want a 1-minute consult/tutorial on this case? See yellow area from sample page below.
- Want to know what happened with this patient? See case conclusion below tutorial page.
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CASE CONCLUSION: Hb dropped from 12 to 8. Patient went to IR for embolization
CASE LESSONS: