6-year-old previously healthy girl arrives by ambulance. Initially somnolent, tachycardic, hypoxic and hypotensive. In the ambulance a peripheral venous line was placed and Ringer acetate set for infusion. During transport, five minutes from the hospital, she suddenly lost consciousness and stopped breathing. Assessed as cardiac arrest CPR was started. Upon arrival there was no palpable pulses or meassurable BP. CPR was continued. ECG showed a narrow complex SVT with a rate of 130 BPM. Hence PEA until echo. Adrenaline was administered, CPR continued. A bolus of 800cc fluid ex-juvantibus was administered without effect. Bedside echo during CPR seen below.
Taking the clinical scenario and echo into account, it was considered reasonable to suspect septic shock and the patient was immediately treated with 1L bolus of fluid due to grave hypovolemia. Furthermore, rapid overview ultrasound shows the following findings in the lateral lung quadrant.
A normal lung ought to beyond the superficial pleura have a black and grey appearance without any organized structures, so called artifacts since the air level can’t reflect the sound waves. In this case we can see organized echogenic consolidations in the lung. Most frequently these changes represent severe pneumonia with empyema or a tumor. Overall assessment was severe hypovolemia secondary to pneumosepsis with shock. The patient responed to the fluid bolus, regained pulse and blood pressure, and was admitted to the intensive care unite for further treatment. She was discharged home 10 days later without any complications.