Case No. 185

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Case No. 185


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Chief Complaint:


Published: Jan. 2, 2018
Author: YourDesignMedical

57 year old man, no PMH, presents to the ED complaining of generalized weakness. He reports a "cold" 2 weeks ago, and since then has had worsening weakness. He can barely get out of bed and is unable to stand up. His wife shows you a packet of papers from a nearby ED which includes normal labs, XR, and a viral panel positive for RSV. He denies chest pain, dyspnea, abdominal pain, nausea/vomiting/diarrhea, fevers. VITALS: BP 96/40 -- HR 94 bpm -- T 37C -- O2 97% on RA when standing BP 84/36 -- HR 96 bpm He is seen by a junior resident, who orders basic labs, trop, ecg, and chest x-ray. Which are all benign. He gives 1L of NS as an intervention. 1 hour later you walk by the room, the patient appears pale, weak. The monitor reads BP 82/38 and the 1L of IVF near the bed side is empty. You review his labs, which are all normal. Your eyebrow slowly raises...


What is the next best diagnostic study?

  • CTA Chest
  • Repeat labs including Hb and lactate
  • Bedside ultrasound
  • Respiratory Viral PCR Panel

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