Case 05

90 yo female recently admitted for pneumonia p/w worsening shortness of breath and weakness x2-3 days. No nausea, vomiting, fevers.  Decreased appetite.  Pt uses 2L O2 at home.

PHYSICAL:

VS: Pulse: 120,  RR: 20,  BP 130/62,  O2 sat 96% on 2L NC

CONSTITUTIONAL: The patient is alert and in no apparent distress. Appears WDWN.
EYES: PERRL, lids and conjuntivae are normal on exam.
CARDIOVASCULAR: Rate: Tachycardia. Rhythm: Regular. Gallop: None. Capillary refill time: <2 seconds. Right Dorsal Pulses: NL. Left Dorsal Pulses: NL. Murmur: None.
RESPIRATORY: Mild Respiratory distress. Barrel Chest: No; Pursed-lip breathing: No; Productive cough: No; Cyanosis: No Wheezing: Absent. Rales: Bilaterally. Rhonchi: Absent. Diminished BS: None. b/l basilar crackles
GI/ABDOMEN: Soft, non-tender, no organomegly, no pulsatile mass. Normal bowel sounds.
MUSCULOSKELETAL/EXTREMITIES: Tenderness: Non-tender. ROM: Normal ROM. Pedal Edema: Bilateral pedal edema on exam. Neck Exam: The neck is supple, no JVD, thyromegaly, or lymphadenopathy.
INTEGUMENTARY: Color normal for race, warm and dry, no rash.
NEURO: Oriented x3. Cranial nerves II-XII within normal limits. No motor or sensory deficits.

1. What is depicted below? 

2. What ultrasound exam are we performing below and what do we see?  What does this indicate?

3. Where is the probe position for the images below?  What do the images below depict?

4. What do you think is causing the pt's shortness of breath?