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50y
HTN. Hx of Episodic sweating & palpitations.
< 12h SOB + diaphoresis
BP 220/120. HR 125. SpO2 80% CRT >5
#POCUS bilat B lines + RUQ mass
Tx: NIV + CI
1° 
NTG + 2° Labetalol* 
Stable
Emergent
to tertiary center (4k km)
Pheochromocytoma 
[1/3]
HTN. Hx of Episodic sweating & palpitations. < 12h SOB + diaphoresisBP 220/120. HR 125. SpO2 80% CRT >5
#POCUS bilat B lines + RUQ mass
Tx: NIV + CI
1° NTG + 2° Labetalol* StableEmergent
to tertiary center (4k km)Pheochromocytoma [1/3]
[2/3]
Medical team decides ETI for transfer (questionable, considering 
response to NIV & )
Plasma free metanephrines (++) confirm Dx.
Anesthesia: “To unstable to operate, wait..”
Finally:
waiting for a more appropriate time..
#POCUS #FOAMus #FOAMed
Medical
team decides ETI for transfer (questionable, considering response to NIV & ) Plasma free metanephrines (++) confirm Dx. Anesthesia: “To unstable to operate, wait..”
Finally:
waiting for a more appropriate time..#POCUS #FOAMus #FOAMed
[3/3]*
Note
Labetalol is
recommend for Tx 
Weak α blocker effect, non selective B
(1:5, α: β). Could make worse the HTN and precipitate hemodynamic collapse.
Drug of choice in crisis are IV α(not available in 
), or nitropussiate (not available in my ).
Note Labetalol is
recommend for Tx Weak α blocker effect, non selective B
(1:5, α: β). Could make worse the HTN and precipitate hemodynamic collapse.Drug of choice in crisis are IV α
(not available in ), or nitropussiate (not available in my ).
