Complex Pericardial Effusion with Tamponade on POCUS Echocardiogram - A4C Pt sent to ED c intradialytic hypotension. ESRD d/t Lupus nephritis. Poorly compliant c dialysis. BUN/Cr- 128/9.4. Given several fluid boluses in dialysis but BP remained 90 systolic. Dialysis stopped after 1 hour. Patient states was well prior. K 5.9 without EKG changes. Pt has large pericardial effusion along with rt/lt pleural effusions. Note RA collapse on Apical 4. IVC plethoric. MV inflow decrease with insp >25%. BP improved in ED to 106 systolic. D/T echo findings, taken to cath lab-pericardiocentesis performed. About 950 ml removed. Pericardial fluid exudative. Cultures including TB negative. Admitted to ICU. Intradialytic hypotension is common. Even though frequently benign causes, need to consider serious causes such as pericardial effusion/tamponade. Dr. Robert Jones @RJonesSonoEM #Complex #Pericardial #Effusion #Cardiac #Tamponade #POCUS #Echocardiogram #A4C #clinical #cardiology
