docnikki
Forum Guru
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Hi friends..this is a quest from online Q bank..I have a problem in agreeing to the answer they gave..plz tell me what answer you all choose 
Attached Files:
PE QUEST..doc (204 KB, 33 downloads)
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| Justice
Just signed contract
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Posts: 2,369
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I would do dopler (B)... Need for IVC filter has to be documented. The intracranial hemorrhage is relevant to hep treatment...
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| doc_clotaire
Forum Guru
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I would choose C ( IVC filter placement )
This patient had an intracranial hemorrhage secondary to heparin administration , so futher anticoagulation is contraindicated
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| dr.wad
Forum Senior
Topics: 3
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( D ) . do nothing.
there is no any evidence of prior DVT, and at this time ( for sure ) doppler was done for this patient and of course it ws negative.
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| sprint123
Forum Guru
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I would go in for IVC filter..since Pulmonary embolism had already occurred and there is CI for thrombolytics or anti-coagulants.
He has h/o pancreatic CA and possibilty of hypercoagulability cannot be ruled out.Hence,DVT plays only a secondary role.Even if DVT is positive or negative NOW---He could develop in the future due to his H/o pancreatic cancer and hence IVC filter is the treatment of choice...I think
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| docnikki
Forum Guru
Topics: 93
Posts: 680
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I also agree that IVC filter is necessary..since now he has a contraindication to heparin and thrombolytics...But since they are asking next step..just like "justice" I also thought we will first document the presence of DVT by doppler and then ofcourse we have to place the IVC filter..
but it seems that its not as important for documenting DVT and assumed that its 100% DVt the culprit.
Sprint..u are right hypercoagulabilty might be due to pancreatic ca..but again IVC filter will protect from embolus coming from leg veins...so that means prtecting from DVT only...
So U all say we will go for the invasive procedure without documenting presence of DVT by doppler?
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Hi docnikki..here is what I think
If the doppler is positive also-You have to place a IVE filter due to the CI for anti-coagulation
If the doppler is negative,You can prevent further embolism from DVT by placing IVC filter.
True...We are preventing only DVT and not the hypercoagulability of pancreatic cancer but we CANNOT prevent the latter but we could prevent the recurrent EMBOLI from RECUURENT dvt,if it forms due to the Pancreatic cancer...
I think I have confused everyone a lot---No problem---If anyone could confuse me more I WOULd really appreciate that
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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In concise,the point is ----DOING DOPPPLER IS NOT GOING TO ALTER THE TREATMENT-Neways,IVC filter has to be kept for furthe embolism,irrespective of the doppler results
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| docnikki
Forum Guru
Topics: 93
Posts: 680
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I totally agree sprint123. Thanks alot. i understood very nicely your approach and thats right coz afterall answer is also IVC filter. it is a very good question no doubt.
thanks everyone. GL!
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