fongch
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PE is suspected in a postoperative patient for hip replacement. Her BP 100/50mmHg, PR 120/min, RR 36/min. She is afebrile and is saturating 84%on 6L oxygen. Lung examination and CXR are unremarkable. The next step?
A Obtain an arterial blood gas
B Intubation
C Order extremity venogram
D Order a V/Q scan
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| Justice
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D Order a V/Q scan
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| doyoudig
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A Obtain an arterial blood gas ?
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| sprint123
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Since CXR is normal and she is hypoxemic--Next best step -V/Q scan
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| doyoudig
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so we do not need ABG to determine Resp Alkalosis + Hypox n Hypocar? if Hypoxemia is already given???
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| Justice
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doyoudig wrote:
A Obtain an arterial blood gas ?
It is a good point... I wrote myself that ABGs should be obtained along with CXR and EKG...
We are already given the last two, so I personally skipped ABGs and moved to making diagnosis rather than establishing A/B state... ABGs, whatever they are, would be nonspecific... the Pt initially will develop resp alkalosis and then acidosis, but this will not help exclude PE... I may be wrong...
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| doyoudig
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I just noticed that this question is from UW, and yes they said that since CXR is already normal, plus Pt ahs incr RR (Low CO) n hypoxemic, ABG will be of no diagnostic Value so in this cases n the next best test is V/Q
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| Justice
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doyoudig wrote:
I just noticed that this question is from UW, and yes they said that since CXR is already normal, plus Pt ahs incr RR (Low CO) n hypoxemic, ABG will be of no diagnostic Value so in this cases n the next best test is V/Q
In addition, the Pt is already on oxygen... No ABG values will be of value...
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| doc_clotaire
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D Big Time 
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| doc_clotaire
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Hey guys ! what about if the options ( for suspected PE ) were to pick between ...........
a ) V-Q Scan or
b ) Start heparin
What would be the best one ?
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| doyoudig
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if both are given as answer choices n they did, all the initail steps (e.g CXR, EKG, ABG) with high suspicion of PE
Go for Treatment 1st then V/Q can be done later (this is all based on the fact that Pe cairries a High Mortality if not Rx in high supicious cases Risk vs Benefits). If V/q came back negative after Rx, then you can always stop the heparin (or whatever Rx may be indicated given the case description)
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| Justice
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doyoudig wrote:
if both are given as answer choices n they did, all the initail steps (e.g CXR, EKG, ABG) with high suspicion of PE
Go for Treatment 1st then V/Q can be done later (this is all based on the fact that Pe cairries a High Mortality if not Rx in high supicious cases Risk vs Benefits). If V/q came back negative after Rx, then you can always stop the heparin (or whatever Rx may be indicated given the case description)
Agree... Then give Heparin... Suspicion in PE is the best test
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| doc_clotaire
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You guys are all PE Certified
I hope we will get all PE questions right on boards
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| ram3
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The patient is not saturating well no use in doing ABG the answer is V/Q scan BIG TIME the order usually is ABG THEN CXR THEN ECG THEN V/Q SCAN
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| doyoudig
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ram woudn you do ekg 1st, since this is more impt than ABG esp if Sx of heart??
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| zainee
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pt has 86 sat on o2 , shouldnt we intubate her??
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