Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)
Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed. This post discusses several components of sepsis evaluation and management in the ED, followed by key references.
Mini-Case #3: Why is my Aortic Stenosis patient getting sicker?
A patient presents to the ED with severe shortness of breath and lower extremity swelling over the three days. His VS include BP 100/62, HR 110, T 37.8C, RR 23, O2 saturation 90% on RA. You detect a grade IV/VI systolic ejection murmur with radiation to the carotids bilaterally.
Considerations:
1) How do aortic stenosis patients present to ED?
2) What comprises ED-relevant management? How do you balance preload/afterload, and when do you use inotrope/vasopressor?
3) When the ship is sinking, who should you call?
4) Sepsis + GI bleed + aortic stenosis…How do you balance other conditions in the patient with aortic stenosis?
5) How do you optimize intubation of the patient with aortic stenosis?
6) What are other valve emergencies we may see in ED setting?
Suggested Resources:
http://www.emdocs.net/management-of-the-crashing-aortic-stenosis-patient/
https://wikem.org/wiki/Aortic_stenosis
http://www.emdocs.net/acute-valvular-emergencies-pearls-pitfalls/
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