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Presenter: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart hospital, Doha, Qatar
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Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

Mar 02, 2020

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Page 1: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

Presenter:

Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart hospital, Doha, Qatar

Page 2: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

39 y old man

No known chronic illness

married, non smoker, occasional alcoholic. no drug abuse

Came to ER with sever headache, fever 39, confused, no respiratory symptoms.

was not cooperative and not giving history

Page 3: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

On exam 115/78 . P90 t 39

chest : clear equal bilateral.no tachypnea heart :s1, s2 no additional sound abdomen : soft lax, no tenderness.

Page 4: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

CT head done normal

Page 5: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

PATIENT HEMODYNAMICALLY NOT STABLE , HYPOTENSION 68/44 , PULSE 140 , RR 22 , CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated

Page 6: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 7: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 8: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

LP consistent with bacterial meningitis Blood cultures grew MRSA Nasal positive MRSA Resp. viral panel negative

Page 9: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

echo

Page 10: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 11: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 12: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 13: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 14: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

The patient was extubated in MICU and then TEE is adviced

Page 15: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 16: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 17: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 18: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 19: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 20: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 21: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 22: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 23: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 24: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 25: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 26: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 27: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 28: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

Follow me with this

Page 29: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 30: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 31: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

The patient was adviced for surgery and was transferred to HH

Another TEE was done

Page 32: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 33: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 34: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 35: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 36: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 37: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 38: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 39: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent
Page 40: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

Pt refused surgery he wants to do it in his home country

Was discharged on Ab

Page 41: Dr Bassim Albizreh, MD, echo subspeciality fellow, Heart ... · CANCEL LP , contact ICU ICU : pt became agitated when reached MICU , desaturated and was intubated and sedated LP consistent

thanks