BRCU 2024: Test Your Knowledge
A 66-year-old man presents to the hospital with new-onset chest pain. He is found to have an aortic dissection and is brought to the operating room for emergent repair. Postoperatively, examination of the patient reveals his BP is 88/60 mm Hg and heart rate is 96 bpm. He remains intubated with a fraction of inspired O2 of 70%. He has crackles in bilateral lung bases and 2+ edema is present. The patient is anuric despite Foley catheter placement.
Laboratory results show the following concentrations: Na, 138 mEq/L; K, 6.5 mEq/L; and bicarbonate, 15 mEq/L. Because of volume excess and hyperkalemia, a dialysis catheter is placed to start kidney replacement therapy.
Image taken by author.
After reviewing the radiograph, which of the following is the next best step in management?
- Advance the catheter.
- Initiate renal replacement therapy.
- Pull back the catheter.
- Call for a vascular surgeon.
Reference:
- Wierstra, B., K. Rommers, P. Cantle, and S. Au. "Arterial Placement of Central Venous Catheters: Beyond Prevention to Management." Canadian Journal of General Internal Medicine 15, no. 3 (2020): 45–8.
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