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Case No. 185

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Weakness

Clinical Scenario
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...
Question
What is the next best diagnostic study?
  • CTA Chest
  • Repeat labs including Hb and lactate
  • Bedside ultrasound
  • Respiratory Viral PCR Panel
  • Question
    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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