Daily Archives: September 18, 2019

This week is a case of a 29 yo F with known severe pulmonary hypertension. The etiology was thought secondary to cocaine-induced idiopathic pulmonary arterial hypertension. Unfortunately, she sustained a cardiac arrest (you’ll see why when you look at the images). ROSC was obtained and she was transferred to the ICU. Despite maximal medical support of her RV (optimal ventilator management, IV flolan, inhaled nitric oxide, inotropes including milrinone and vasopressin) she had persistent hypotension and worsening renal failure necessitating CRRT. The overnight team decided to trial some small boluses of crystalloid to see if that would help. Have a look at the images below and decide whether or not you would give fluids or recommend something else? If I said the CVP (as measured from the right IJ central line) was 22, what would the estimated RVSP be?