Hemodynamic instability and fluid responsiveness

摘要

The rapid response team was called to evaluate a 64-yr-old hypotensive and hypoxic female patient hospitalized for deep venous thrombosis. Low-molecular-weight heparin had been initiated two days previously. The rapid response team observed her vital signs: heart rate, 110 beats-min-1; blood pressure, 90/65 mmHg; and oxygen saturation, 90% while receiving 100% oxygen via a non-rebreather face mask. Using bedside focused ultrasonography, the patient's inferior vena cava was found to be < 2 cm and to collapse during inspiration. Lung ultrasonography revealed a spontaneous left-sided hemothorax. She was transferred to the intensive care unit, and a chest tube was inserted while coagulation was corrected using fresh frozen plasma. A chest radiograph confirmed the left-sided hemothorax. An inferior vena cava filter was inserted and the patient's condition rapidly stabilized. She was discharged from hospital three days later.