Critical Care and Ultrasound at the Bedside

00:01:04,744 Before we did the ultrasound, 32 00:01:04,744 --> 00:01:07,455 and she said, "Let's put a Swan-Ganz catheter in," 33 00:01:07,455 --> 00:01:09,814 which was what we were doing before and still are doing 34 00:01:09,814 --> 00:01:11,381 for some indications, 35 00:01:11,381 --> 00:01:12,821 so when you wanna know what's the pressure 36 00:01:12,821 --> 00:01:14,762 in the left side, right side of the heart 37 00:01:14,762 --> 00:01:16,633 putting on the artery, you can do that. 38 00:01:16,633 --> 00:01:18,443 Put that catheter that has been there since 39 00:01:18,443 --> 00:01:19,764 the early seventies. 40 00:01:19,764 --> 00:01:21,395 But, you know, it's a central line. 41 00:01:21,395 --> 00:01:22,835 You have to have access to the patient, 42 00:01:22,835 --> 00:01:24,365 you have potential infection risk. 43 00:01:24,365 --> 00:01:27,019 In five minutes, we were able to look at the lung, 44 00:01:27,019 --> 00:01:28,380 look at the heart, 45 00:01:28,380 --> 00:01:31,544 look at the cardiac output, central venous pressure, 46 00:01:31,544 --> 00:01:33,266 and now act on it. 47 00:01:33,266 --> 00:01:35,723 So I told them, "Just a little dose of diuretic. 48 00:01:35,723 --> 00:01:37,428 "If he drops his blood pressure, 49 00:01:37,428 --> 00:01:40,061 "we're gonna bring it up with a basal pressure 50 00:01:40,061 --> 00:01:42,811 "to increase the vascular resistance of the vessels, 51 00:01:42,811 --> 00:01:45,362 "not by giving more fluid, because he has enough. 52 00:01:45,362 --> 00:01:48,794 "And we're gonna get fluid out by a mechanical way," 53 00:01:48,794 --> 00:01:51,253 meaning that we're gonna put a catheter in, getting it out, 54 00:01:51,253 --> 00:01:54,170 trying to both help his pressure problem, 55 00:01:54,170 --> 00:01:57,230 blood pressure problem, and his oxygenation problem. 56 00:01:57,230 --> 00:01:59,108 So that's, you know, just in a few minutes, 57 00:01:59,108 --> 00:02:00,547 changing what we can do. 58 00:02:00,547 --> 00:02:02,042 And clearly, we don't have to move him 59 00:02:02,042 --> 00:02:04,966 to do a CT scan, we don't have to put any needles in him, 60 00:02:04,966 --> 00:02:07,677 apart from the one we're gonna take to put 61 00:02:07,677 --> 00:02:09,847 the catheter right here, 62 00:02:09,847 --> 00:02:12,088 and we'll see how it goes, 63 00:02:12,088 --> 00:02:13,677 but we know exactly where we're heading, 64 00:02:13,677 --> 00:02:15,071 all at the bedside. 65 00:02:15,071 --> 00:02:18,488 (violin and piano music) "/>