Female With Hypotension

Abstract

A 50-year-old woman with a history of diabetes and meningeal tuberculosis presented with 3 days of shortness of breath and fatigue. Abnormal vital signs included tachycardia (pulse rate of 135 beats/min) and a temperature of 38.1 °C (100.6 °F). Physical examination revealed altered mental status and cold, clammy extremities. Laboratory investigations were significant for lactate levels of 2.5 mmol/L and WBC count of 18 cells/nL. Point-of-care ultrasound revealed a loculated pericardial effusion (Figure 1 and Video E1, available online at http://www.annemergmed.com) and a dilated inferior vena cava without right atrial collapse (Figure 2 and Video E2, available online at http://www.annemergmed.com).