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 42-year-old patient underwent spondylodesis of Th11-L1 for vertebral fracture. Surgery was performed using a combination of dorsal and ventral left-sided thoracotomy. The patient was transferred to ICU for dyspnea. CT was performed. Atelectasis of upper lobe of the right lung, atelectasis of lower lobe of the left lung and residual pneumothorax ventrally on the …
A patient underwent surgery for peritonitis some time ago. Preoperative CT revealed hypodense lesions in the liver and right adrenal gland. Abdominal ultrasonography:
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:
An old patient with a history of COPD was admitted to the ICU for hypercapnic respiratory failure (pCO2 92 mmHg, pO2 70 mmHg, pH 7.3, BE +18 mmol/l). Level of consciousness improved after non-invasive ventilation was started. Auscultation revealed diffuse rhonchi. No expectoration was present. Chest X-ray performed during admission revealed neither infiltration nor effusion. …
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 …
Ultrasonography of a patient in sepsis. Septic focus is suspected to be localised in the abdominal cavity. A patient underwent right-sided hemicolectomy one week ago. She had to be intubated due to the development of sepsis and MODS. She received mechanical ventilation. A nasogastric tube was inserted. Let´s suppose you just finished echocardiography (the patient …
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 …
An 80-year-old patient came to an emergency for repeated syncopes (three times last week, she had not searched for medical help before). Significant bradycardia of 28 bpm was revealed. ECG showed junctional rhythm in the terrain of sinus arrest. Lab tests revealed slight elevation of leucocytes (12 900 with 59% of neutrophils), CRP 52 mg/l, creatinine …
