dr79
Forum Senior
Topics: 17
Posts: 64
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guys there is another confusion for me....
in pulmonary embolism...acute....i knew according to kaplan lectures,best step is to do ventilation perfusion scan
but according to usmleworld....in a patient with acute PE...best next step is to do his ABG's
to see hypoxemia and hypocarbia
now which one is the bet next step???????????
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| ayeshah_l
Forum Elite
Topics: 29
Posts: 284
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I think V/Q , 'cuz it can be diagnostic. ABG's sure but even if they are messed up, u can't diagnose PE by ABG's alone!!!
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| dr79
Forum Senior
Topics: 17
Posts: 64
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thanx for reply...
ya u r rite...and i was of this view too....but i got worried by usmleworld explanation...
anyone else can clear us plzz
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| nightflight1945
Forum Senior
Topics: 19
Posts: 221
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For dignosis of PE you need V/P scan but after u have diagnosed it , ABG will be the first step to evaluate patient
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| dr79
Forum Senior
Topics: 17
Posts: 64
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thanx alot
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| dr79
Forum Senior
Topics: 17
Posts: 64
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ok people...u say...do V/Q scan first....then wts the need of ABG's if V/Q has already been done.....treatment shud be started immediately for PE.....aint it?
here is a ques which is frm UW....that choriocarcinoma can develop in post partum women...and often presents with shortness of breath and hemoptysis....tats y it is often confused with PE...in such pateints always do chest x rays....beta HCG....and pelvic exam....
BUT...when pt is in actue stage(in choriocarcinoma) we will definately think of PE first ...right??...and at this stage shudnt we do ABG's first to rule out PE....or directly move on to V/Q scan?
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| chemamr
Forum Hero
Topics: 703
Posts: 4,463
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if you suspect PE in a patient and he is arriving to ER, first thing you must do is ABG + CXR (+- ECG) and then if your suspicion continues you go for V/Q scanning.
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| Renegade
Forum Elite
Topics: 18
Posts: 171
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Agreed. Do you know how much longer V/Q takes when compared to ABG, not to mention the cost? PE is almost always so clinically challenging because the patient's complains are so inespecific; expect to see some PE without low CO2 as well! Usually ABG is required asap, along with d-dimers and cbc... only then the suspicion arises, and u go for V/Q. I think the best option is to answer «V/Q» when they say «there is suspicion of PE», and go for «ABG» when they present nothing but a case when you are the one suspecting of PE...
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| drkpp
Forum Guru
Topics: 45
Posts: 882
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most of the times the question gives ABG values and thus the next best step is V/Q.
but otherwise as renegade said ABG is the first step..
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| alenka
Forum Elite
Topics: 22
Posts: 330
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i had a like-it question in Mock exam-the answer was ABG first,then V/Q.-i got it wrong.
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