kmp
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A 33-year-old woman with no significant past medical history is brought to the emergency department with acute onset of severe shortness of breath. She reports that right-sided calf pain developed after a long plane trip home from Australia, and that several hours after the onset of this calf pain she became acutely short of breath. History is difficult to obtain because of the patient's extreme shortness of breath, but her companion reports that she has had no recent surgeries or history of bleeding. Her temperature is 37.8 C (100.0 F), systolic blood pressure is 70 mm Hg, pulse is 140/min, and respirations are 34/min. Physical examination reveals a woman in severe respiratory distress. She is using accessory respiratory muscles. Her heart is rapid and regular, her lungs are clear, and her abdomen is benign. Her right calf is swollen and tender. Ventilation perfusion scan is high probability. Arterial blood gases show:
pH - 7.48
pCO2-20mmHg
pO2-48mmHg or 6L oxygen
Which of the following is the most appropriate management?
A. Embolectomy
B. Low molecular-weight heparin
C. Thrombolysis
D. Unfractionated heparin
E. Warfarin alone
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| msyamp
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C
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| oct
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i go w C too
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| mesh
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C
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| msyamp
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now a days embolectomy is absolete
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| frontal
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Massive thromboembolism and hypotension - so thrombolysis (streptokinase) first, followed by heparin, so yeah, C.
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| oct
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embolectomy for unstable PE patient who has contraindication for Thrombolysis
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| kmp
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The correct answer is C.
This patient has a pulmonary embolism and is hemodynamically unstable. Therefore, she requires a thrombolytic agent to attempt to dissolve the blood clot. The contraindications to thrombolyisis include recent surgery or recent bleeding. Other contraindications to thrombolysis include uncontrolled blood pressure, or age. Because this patient does not have any contraindications, thrombolysis is the most appropriate management.
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| msyamp
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oh thank you good one
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| beat it
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Thrombolytics-one hour golden rule
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