More than meets the “I”

A man in his 60s was brought in by the ambulance as a standby case. He was found by a passerby lying near a rubbish bin.

At the emergency department, he was confused and pale. Vitals: PR 123, RR 25, BP 103/44, temperature 38.4oC. SpO2 was difficult to pick up. The epigastrium was tender.

We rapidly screened the patient using the D HI MAP protocol. The aorta was normal; no B lines in the lung, heart was hyperdynamic. There was some free fluid in the morrison’s pouch. We took a look at the "I"nferior Vena Cava - the focused questions we ask here are Size & Collapsibility. Instead, we found this: a snapshot in end inspiration.

What’s wrong in this picture?


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