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Pulmonary embolus

Thread: Pulmonary embolus

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  1. berdugo75 said:

    Pulmonary embolus

    A 45-year-old Caucasian male comes to the emergency room complaining of shortness of breath that began 3 hours ago. He also has a nonproductive cough, slight fever and right-sided chest pain that worsens with inspiration. He denies coughing up blood, wheezing, palpitations, leg pain or swelling of lower extremities. He recently had a trip to Singapore. Past medical history reveals hypertension for 8 years, and diabetes mellitus for 4 years. His medication includes captopril and glyburide. He is allergic to penicillin. He doesnot smoke. He drinks alcohol occasionally. His vital signs are T: 101 F (38.3C), BP: 115/70 mmHg, PR: 128/min, and RR: 32/min. Physical examination shows slightly obese white man in acute distress. He is alert and cooperative without any cyanosis or jaundice. His physical examination reveals slightly displaced apex beat with loud S 4. Chest-x ray shows mild cardiomegaly. EKG shows sinus tachycardia and left ventricle hypertrophy; no acute ST-T changes seen. His Arterial Blood Gases shows: pH 7.52, pCO2 30, pO2 60, and 86% O2 saturation on room air. He is started on oxygen. What is the next best step in the management of this patient?




    A.Ventilation perfusion scan
    B.Pulmonary angiogram
    C.Doppler of lower legs
    D.Spiral CT scan of chest
    E.Start heparin
    F.Give thrombolytic therapy with t-PA
    G.Placement of inferior vena cava filter
    H.Embolectomy
    I.Cardiac enzymes
    J.PTCA
    K.Echocardiogram
     
  2. Neurosurg777 said:
    Quote Originally Posted by berdugo75 View Post
    A 45-year-old Caucasian male comes to the emergency room complaining of shortness of breath that began 3 hours ago. He also has a nonproductive cough, slight fever and right-sided chest pain that worsens with inspiration. He denies coughing up blood, wheezing, palpitations, leg pain or swelling of lower extremities. He recently had a trip to Singapore. Past medical history reveals hypertension for 8 years, and diabetes mellitus for 4 years. His medication includes captopril and glyburide. He is allergic to penicillin. He doesnot smoke. He drinks alcohol occasionally. His vital signs are T: 101 F (38.3C), BP: 115/70 mmHg, PR: 128/min, and RR: 32/min. Physical examination shows slightly obese white man in acute distress. He is alert and cooperative without any cyanosis or jaundice. His physical examination reveals slightly displaced apex beat with loud S 4. Chest-x ray shows mild cardiomegaly. EKG shows sinus tachycardia and left ventricle hypertrophy; no acute ST-T changes seen. His Arterial Blood Gases shows: pH 7.52, pCO2 30, pO2 60, and 86% O2 saturation on room air. He is started on oxygen. What is the next best step in the management of this patient?




    A.Ventilation perfusion scan
    B.Pulmonary angiogram
    C.Doppler of lower legs
    D.Spiral CT scan of chest
    E.Start heparin
    F.Give thrombolytic therapy with t-PA
    G.Placement of inferior vena cava filter
    H.Embolectomy
    I.Cardiac enzymes
    J.PTCA
    K.Echocardiogram

    E. Start heparin

    If it had said what is the next best step in diagnosis then D (spiral CT) would have been right.
     
  3. Montgomery said:
    E.Start heparin

    embolectomy if hemodynamically unstable.
     
  4. CSREVIEW said:
    Heparin ofcourse
     
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