Correct!
4. 1 and 3

D-dimers are sensitive but not specific (2). In other words, a deep venous thrombosis (or its complication pulmonary embolism) is unlikely with a normal D-dimer but an elevated D-dimer is not diagnostic of pulmonary embolism. In this situation with hypotension, the elevated lactic acid likely indicates inadequate tissue perfusion. A point of care ultrasound can be quite useful in assessing hypotension in the ICU (3).

An ultrasound was performed. The inferior vena cava was 2.8 cm in diameter (normal 1.5-2.5 cm in adults). The subcostal ultrasound of the heart is shown in figure 3.

Figure 3. Video of subcostal ultrasound of the heart.

Which of the following is/are true? (Click on the correct answer to proceed to the fifth of seven pages)

1. The dilated inferior vena cava is consistent with volume overload
2. The left ventricle is hypokinetic
3. There is a left to right shunt at the level of the ventricles
4. 1 and 3
5. All of the above

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