You are working in the resus room, when a 65yoM h/o CAD, severe aortic stenosis, dilated cardiomyopathy (EF 15%), presents short of breath in extremis.
VS: 75/60, HR 119 RR 24, T98.0, Sp02 94% on NRB
He has rales to the apices of the lungs bilaterally.
Loud systolic murmur radiating to his carotids.
He is pale and diaphoretic. Hypotensive with flash pulmonary edema, underlying poor cardiac contractility, with an obstruction to cardiac output.
You are concerned.
As you are formulating your approach to this patient, an intern urgently asks what tubes he needs to send for a paracentesis at Sinai.