A 40-year-old woman admitted with fever, chills, and changing mental status is transferred to the ICU with a clinical suspicion of sepsis. Examination shows sinus tachycardia, no murmur, and clear lung fields. The patient is given IV fluids aggressively for hydration. Blood cultures are drawn and the patient is placed on antibiotics. Subcutaneous heparin is given for thromboembolic prophylaxis. As the patient does not improve satisfactorily, a procedure is performed. One hour after this procedure, the patient suddenly develops moderate hemoptysis. A CXR is done.The next step should be
Correct Answer: Withdraw the catheter
Description: This chest x-ray shows a pulmonary aery catheter inseed through the internal jugular vein. The PA catheter extends peripherally beyond the right ventricular shadow and past the main pulmonary aery branches into the subsegmental vessels. The patient presents with sepsis and septic shock. It is impoant to determine the fluid status of the patient, especially if no improvement is noted with initial fluid challenge. The procedure performed was a placement of a pulmonary aery catheter to determine the capillary wedge pressure. The PA catheter in this case extended peripherally into the small vessels and thereby caused pulmonary infarction. The hemoptysis represents that complication, and withdrawal of the catheter is of utmost priority. Other options outlined are inappropriate or inapplicable.
Category:
Radiology
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