Conversation
11 April 2026 · 07:04 · Session focus: Ms. Fatima Rahman, CICU bed 1 · 2 turns
Earlier in this conversation · 07:01
“How does my day look?”
→
Shift briefing for 11 patients · 4 priority · Fatima / Pillai / Nair / Krishnan / Rao surfaced.
“Tell me more about Ms. Fatima.”
07:03:52 · 1.1s
Confirmed: Ms. Fatima Rahman, 28F · CICU bed 1 · MRN AST-2026-04-1142
OmniSense · patient briefing
2.1s · context bundle 4.8 KB
Ms. Fatima is a previously well 28-year-old admitted overnight at 04:18 with a
five-day history of flu-like symptoms followed by sudden-onset chest tightness and breathlessness.
She was brought in by her husband. By the time she reached resus she was hypotensive and
peripherally shut down.
Her presenting troponin was 14.2 ng/mL, BNP 2,180, and the bedside echo at 04:48 showed global hypokinesia with EF around 28 %. The working diagnosis is acute viral myocarditis — influenza A swab is positive, no coronary disease on the emergency angiogram. CRP 184. White cell count 13.6.
She’s currently on noradrenaline 0.08 mcg/kg/min and dobutamine 5 mcg/kg/min. MAP is sitting at 62. Lactate trended from 4.8 down to 3.6, but the repeat echo at 06:42 shows EF has dropped to 22 and there’s new right-ventricular strain. Urine output has dropped to 18 mL/h over the last hour.
The active question for you is the ECMO team’s ask — Dr. Krishnamurthy and the perfusion team are at the bedside now. They want to know whether to cannulate for VA-ECMO immediately, or continue medical support and reassess at 11:00. The trajectory of the EF, the rising lactate-MAP gap, and the falling urine output all point in the same direction.
She is on broad-spectrum cover (meropenem) and IVIG is being prepared but not yet given. No anticoagulation contraindications. Allergy to penicillin (rash only). No prior cardiac history. Husband and parents are at the unit.
Her presenting troponin was 14.2 ng/mL, BNP 2,180, and the bedside echo at 04:48 showed global hypokinesia with EF around 28 %. The working diagnosis is acute viral myocarditis — influenza A swab is positive, no coronary disease on the emergency angiogram. CRP 184. White cell count 13.6.
She’s currently on noradrenaline 0.08 mcg/kg/min and dobutamine 5 mcg/kg/min. MAP is sitting at 62. Lactate trended from 4.8 down to 3.6, but the repeat echo at 06:42 shows EF has dropped to 22 and there’s new right-ventricular strain. Urine output has dropped to 18 mL/h over the last hour.
The active question for you is the ECMO team’s ask — Dr. Krishnamurthy and the perfusion team are at the bedside now. They want to know whether to cannulate for VA-ECMO immediately, or continue medical support and reassess at 11:00. The trajectory of the EF, the rising lactate-MAP gap, and the falling urine output all point in the same direction.
She is on broad-spectrum cover (meropenem) and IVIG is being prepared but not yet given. No anticoagulation contraindications. Allergy to penicillin (rash only). No prior cardiac history. Husband and parents are at the unit.
§ ESC Myocarditis 2023 · pp. 14-18
§ ELSO ECMO selection criteria
Patient bundle · admission 04:18
Echo report · 06:42
Lab trend · 04:30 → 06:50
Allergy registry · AST-2026-04-1142
Vitals snapshot — 06:58
BP
88/52
MAP 62 · was 94/58
HR
128
sinus tach
SpO₂
93 %
on 6L NC
EF
22 %
was 28 %
Lactate
3.6
was 4.8
UO
18
mL/h · was 38
Trop
14.2
ng/mL on adm
CRP
184
expected
Ask a follow-up about Ms. Fatima
Pronouns will resolve to her automatically. Try:
“What’s the concern?” ·
“Should we cannulate?” ·
“Pull up her echo”