<p begin="00:00:00.264" end="00:00:02.764" style="s2">(piano music)</p>
<p begin="00:00:07.025" end="00:00:08.273" style="s2">- [Yanick] So he's the<br />gentleman that had a trauma</p>
<p begin="00:00:08.273" end="00:00:09.174" style="s2">about two weeks ago.</p>
<p begin="00:00:09.174" end="00:00:10.007" style="s2">(piano music)</p>
<p begin="00:00:10.007" end="00:00:10.942" style="s2">Motor vehicle accident,</p>
<p begin="00:00:10.942" end="00:00:14.474" style="s2">and we were wondering<br />if he was full or dry.</p>
<p begin="00:00:14.474" end="00:00:16.708" style="s2">Ultrasound can give us<br />a precise evaluation of</p>
<p begin="00:00:16.708" end="00:00:18.545" style="s2">is there fluid?</p>
<p begin="00:00:18.545" end="00:00:19.378" style="s2">Where is it?</p>
<p begin="00:00:19.378" end="00:00:20.590" style="s2">Is it safe to tap it?</p>
<p begin="00:00:20.590" end="00:00:23.207" style="s2">And, qualitatively, how<br />much fluid can there be?</p>
<p begin="00:00:23.207" end="00:00:26.316" style="s2">When we were giving him<br />diuretics to empty him,</p>
<p begin="00:00:26.316" end="00:00:27.737" style="s2">he's dropping his blood pressure.</p>
<p begin="00:00:27.737" end="00:00:28.741" style="s2">So in this case here,</p>
<p begin="00:00:28.741" end="00:00:30.616" style="s2">we wanted to see if there was some fluid</p>
<p begin="00:00:30.616" end="00:00:32.622" style="s2">to get tapped out, which we found.</p>
<p begin="00:00:32.622" end="00:00:35.387" style="s2">Plus, I could see he had<br />a normal heart function,</p>
<p begin="00:00:35.387" end="00:00:36.771" style="s2">so the heart is beating well.</p>
<p begin="00:00:36.771" end="00:00:38.151" style="s2">He had a normal cardiac output;</p>
<p begin="00:00:38.151" end="00:00:39.943" style="s2">no major valvular problem.</p>
<p begin="00:00:39.943" end="00:00:43.289" style="s2">And, I could see that<br />he is fluid-overloaded.</p>
<p begin="00:00:43.289" end="00:00:45.645" style="s2">He has a large dilated inferior vena cava,</p>
<p begin="00:00:45.645" end="00:00:47.485" style="s2">with no variation with breathing,</p>
<p begin="00:00:47.485" end="00:00:50.080" style="s2">telling me that he has<br />some fluid overload.</p>
<p begin="00:00:50.080" end="00:00:52.610" style="s2">At the same time, he<br />needs that fluid overload</p>
<p begin="00:00:52.610" end="00:00:54.354" style="s2">to keep a good circulation,</p>
<p begin="00:00:54.354" end="00:00:57.069" style="s2">because his blood pressure are borderline.</p>
<p begin="00:00:57.069" end="00:00:59.021" style="s2">So we were able to answer all of that.</p>
<p begin="00:00:59.021" end="00:01:00.775" style="s2">And the first question,<br />when I asked my resident,</p>
<p begin="00:01:00.775" end="00:01:03.120" style="s2">"What do you want to do<br />to have some answers?"</p>
<p begin="00:01:03.120" end="00:01:04.744" style="s2">Before we did the ultrasound,</p>
<p begin="00:01:04.744" end="00:01:07.455" style="s2">and she said, "Let's put<br />a Swan-Ganz catheter in,"</p>
<p begin="00:01:07.455" end="00:01:09.814" style="s2">which was what we were doing<br />before and still are doing</p>
<p begin="00:01:09.814" end="00:01:11.381" style="s2">for some indications,</p>
<p begin="00:01:11.381" end="00:01:12.821" style="s2">so when you wanna know what's the pressure</p>
<p begin="00:01:12.821" end="00:01:14.762" style="s2">in the left side, right side of the heart</p>
<p begin="00:01:14.762" end="00:01:16.633" style="s2">putting on the artery, you can do that.</p>
<p begin="00:01:16.633" end="00:01:18.443" style="s2">Put that catheter that<br />has been there since</p>
<p begin="00:01:18.443" end="00:01:19.764" style="s2">the early seventies.</p>
<p begin="00:01:19.764" end="00:01:21.395" style="s2">But, you know, it's a central line.</p>
<p begin="00:01:21.395" end="00:01:22.835" style="s2">You have to have access to the patient,</p>
<p begin="00:01:22.835" end="00:01:24.365" style="s2">you have potential infection risk.</p>
<p begin="00:01:24.365" end="00:01:27.019" style="s2">In five minutes, we were<br />able to look at the lung,</p>
<p begin="00:01:27.019" end="00:01:28.380" style="s2">look at the heart,</p>
<p begin="00:01:28.380" end="00:01:31.544" style="s2">look at the cardiac output,<br />central venous pressure,</p>
<p begin="00:01:31.544" end="00:01:33.266" style="s2">and now act on it.</p>
<p begin="00:01:33.266" end="00:01:35.723" style="s2">So I told them, "Just a<br />little dose of diuretic.</p>
<p begin="00:01:35.723" end="00:01:37.428" style="s2">"If he drops his blood pressure,</p>
<p begin="00:01:37.428" end="00:01:40.061" style="s2">"we're gonna bring it<br />up with a basal pressure</p>
<p begin="00:01:40.061" end="00:01:42.811" style="s2">"to increase the vascular<br />resistance of the vessels,</p>
<p begin="00:01:42.811" end="00:01:45.362" style="s2">"not by giving more fluid,<br />because he has enough.</p>
<p begin="00:01:45.362" end="00:01:48.794" style="s2">"And we're gonna get fluid<br />out by a mechanical way,"</p>
<p begin="00:01:48.794" end="00:01:51.253" style="s2">meaning that we're gonna put<br />a catheter in, getting it out,</p>
<p begin="00:01:51.253" end="00:01:54.170" style="s2">trying to both help his pressure problem,</p>
<p begin="00:01:54.170" end="00:01:57.230" style="s2">blood pressure problem, and<br />his oxygenation problem.</p>
<p begin="00:01:57.230" end="00:01:59.108" style="s2">So that's, you know,<br />just in a few minutes,</p>
<p begin="00:01:59.108" end="00:02:00.547" style="s2">changing what we can do.</p>
<p begin="00:02:00.547" end="00:02:02.042" style="s2">And clearly, we don't have to move him</p>
<p begin="00:02:02.042" end="00:02:04.966" style="s2">to do a CT scan, we don't have<br />to put any needles in him,</p>
<p begin="00:02:04.966" end="00:02:07.677" style="s2">apart from the one we're gonna take to put</p>
<p begin="00:02:07.677" end="00:02:09.847" style="s2">the catheter right here,</p>
<p begin="00:02:09.847" end="00:02:12.088" style="s2">and we'll see how it goes,</p>
<p begin="00:02:12.088" end="00:02:13.677" style="s2">but we know exactly where we're heading,</p>
<p begin="00:02:13.677" end="00:02:15.071" style="s2">all at the bedside.</p>
<p begin="00:02:15.071" end="00:02:18.488" style="s2">(violin and piano music)</p>