Perhaps
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Three days after being hospitalized for treatment of a hip fracture sustained in a fall, a 62-year-old woman becomes acutely short of breath and coughs up a small amount of blood-tinged sputum. She appears anxious. Her blood pressure is 110/70 mm Hg, pulse is 110/min, and respirations are 24/min. Examination shows no other abnormalities. Arterial blood gas analysis on 40% oxygen by face mask shows:
pH 7.40
PCO2 38 mm Hg
PO2 70 mm Hg
Ventilation-perfusion lung scans show multiple segmental areas of mismatch on the right. Which of the following is the most appropriate next step in management?
A) Pulmonary angiography
B) Dopamine therapy
C) Heparin therapy
D) Urokinase therapy
E) Intubation
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| shumaila
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E or C
i think heparinn
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| GDS2008
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Has to be C. Heparin therapy
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| humbty
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Not sure if its not E.
PE should have hyperventilation, she doesnt have that so maybe her respiratory pump is tired and she needs Intubation?
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| GDS2008
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Yea that is a good reason to choose intubation. However, her respiratory rate is still 22/min and although she might need intubation later on, the next best step should still be anti-coagulation. What do you guys think?
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| HighHopes
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I picked C, what is the treatment of pul. embolism? rememeber the problem is perfusion not ventilation....so intubatin patient does not help him....
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| achilles
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why not D-urokinase ?
the patient has been diagnosed with PE and thrombolytics are superior at dissolution of the clot in first 24 hrs. i would choose D.
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| GDS2008
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thrombolytics are only indicated if the patient is hemodynamically unstable.. in PE that is
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| HighHopes
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100% agree with GDS
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| HighHopes
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what if there is saddle embolism? what would u do first?
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| achilles
Forum Guru
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 oh right...agree...its more useful in unstable patient as its use must be in a lifesaving situation.agree with you GDS2008.
so the answer's heparin.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
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| Perhaps
Forum Elite
Topics: 61
Posts: 162
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Thanks everyone.
Confusing question. I don't know heparin or intubate.
Picked heparin when answering the qs, but not sure.
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| frank100
Forum Guru
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Posts: 586
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c also
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