Usefulness of Ultrasound to Help Solve Severe Sepsis Mohammed Abbasi, MD; Yonatan Greenstein, MD; and Seth Koenig, MD, FCCP CHEST 2017; 152(5):e105-e108 A 65-year-old man with a past medical history of schizophrenia, benign prostatic hyperplasia, hypertension, and a chronic suprapubic catheter presented to the ED complaining of subjective fevers and generalized fatigue. He denied cough, dyspnea, and abdominal pain. He denied pain at the suprapubic catheter insertion site. In the ED his temperature was 39.4  C; heart rate, 120 beats/min; blood pressure, 99/51 mm Hg; and respiratory rate, 16 breaths/min. The suprapubic catheter insertion site appeared normal and the catheter was draining clear urine. The abdomen was soft, nondistended, and nontender to palpation. There was no costovertebral angle tenderness present. He was given IV fluids to treat mild hypotension. Laboratory data (Table 1), chest radiograph (Fig 1), and electrocardiogram (Fig 2) are shown. Bloodwork was notable for acute kidney injury and a neutrophil- predominant leukocytosis. The ED physician started broad-spectrum antibiotics for severe sepsis and consulted the medical intensive care unit team. Point- of-care ultrasonography was performed to determine the cause of sepsis and to guide treatment (Videos 1-5). TABLE 1 ] Laboratory Results Admission 24 Hours Postadmission CBC count WBCs, 10 9 /L 14 8.1 Hemoglobin, g/L 8.7 7.4 Hematocrit, % 26.3 22.4 Platelet count, 10 9 /L 254 183 Neutrophils, % 90.60% Basic metabolic profile Sodium, mEq/L 137 137 Potassium, mEq/L 5.4 4.6 Chloride, mEq/L 21 105 CO 2 , mEq/L 20 18 BUN, mg/dL 38 39 Creatinine, mg/dL 2.09 1.53 Glucose, mg/dL 115 101 Liver function tests Total protein, g/dL 7.8 5.6 Albumin, g/dL 3.8 2.8 Total bilirubin, mg/dL 0.3 0.4 AST, U/L 25 35 ALT, U/L 10 16 Alkaline phosphatase, U/L 86 64 pH, VBG 7.42 Lactate, mg/dL 2.2 Urinalysis Blood Small pH 8.5 Nitrite Negative Leukocyte esterase Large WBCs, 10 9 /L > 50 ALT ¼ alanine aminotransferase; AST ¼ aspartate aminotransferase; BUN ¼ blood urea nitrogen; VBG ¼ venous blood gas; WBCs ¼ white blood cells. AFFILIATIONS: From the Montefiore Medical Center (Dr Abbasi), Bronx, NY; and the Hofstra Northwell School of Medicine (Drs Greenstein and Koenig), New Hyde Park, NY. CORRESPONDENCE TO: Mohammed Abbasi, MD, Pulmonary and Critical Care, Yeshiva University Department of Medicine, 111 E210 St, Bronx, NY 10467; e-mail: mabbasi@montefiore.org Copyright Ó 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: http://dx.doi.org/10.1016/j.chest.2017.05.046 [ Ultrasound Corner ] chestjournal.org e105