In light of the ultrasound conference that very few of us could attend:

A dialysis patient presents with mild hypotension and respiratory distress. Bedside ultrasound was done with the parasternal long view shown below. You are unable to acquire any other good views because you are not good at ultrasound.

Which of the following is the best next step: A) Pericardiocentesis , B) Non-invasive ventilation C)Call cardiology and CT surgery D) Both A&C E)All of the above

Inline image 1

Answer: B) Noninvasive ventilation. It may be hard to see in the image, but this is a pleural effusion, not pericardial. It can be discerned by noticing that the effusion is seen going inferior to the descending aorta (it is superior in pericardial effusions). See link for another u/s image to clarify