Abstract
A& 59-year-old white man with a known 15-year history of Crohn’s disease was admitted with complaints ofcough and diarrhea for three days, and chills with fever and light-headedness ofone day’s duration. Physical examination revealed a well-built but malnourished man with HR 120 bpm, respiratory rate 24/ mm, blood pressure 80/60 mm Hg, and signs of dehydration. Chest auscultation revealed bilateral basal rales. Heart sounds were normal. Tentative diagnosis of Crohn’s disease with acute exacerbation, dehydration, and bilateral lower lobe pneumonia was made. His urine output was poor. Multiple attempts to insert a large-bore peripheral catheter were unsuccessful. A triple-lumen CVP catheter was inserted with minimal difficulty using a right subclavian approach. Good blood flow was confirmed and chest x-ray film was obtained (Fig 1). A radiology resident confirmed the catheter placement and absence of pneumothorax. Good CVP readings could not be obtained. The patient was rapidly given 3 L ofintravenous crystalloids using an infusion pump to correct hypovolemia and early shock.
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