DrVirgo
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Dx: PE? E. Intubation or C. Heparin?
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| robin082006
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E
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| elitoki
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ABC is first in any situation.
answer is E
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| cirus
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i don think heparin will have any use here, this is fat embolism, so all we can do-->intubation & support..
in case of a pt with history of fat embolism, and ongoing orthopedic surgery again, should we put a vena-caval filter for prophylaxis (never heard of it, but i thought i would ask), or this is only used in thrombotic emboli??
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| mytime
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E.
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| dr_arc
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D . urokinase.
the woman had had a PE, as substantiated by the V/Q scan. ideally she shopuld be anticoagulated with heparin, but considering her 3 day history of hip fracture for which she is being currently treated, she has to be put on thrombolytics , hence urokinase.
intubationn is not needed rt away.
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| Justice
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elitoki wrote:
ABC is first in any situation.
answer is E
Not in any... This guy is already on an oxygen mask, so this gases are altered...
Heparin is needed immediately
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| lakshya_0_7
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cirus...freind..what makesu think its fat emboli?
i think this is simple PE..just need HEPARIN....
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| dr19
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C.....Heparin
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| dr_arc
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Justice wrote:
Not in any... This guy is already on an oxygen mask, so this gases are altered...
Heparin is needed immediately
considering her 3 day fracture hip , would heparin be permissible here. i think her possible postop status is a contraindication for heparin, so we do the next best thing and thrombolyse her, in this case the option offered is urokinase, what do you think abt this?
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| radonc
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I think heparin too. This lady does not need to be tubed. Her pH is OK, not acidotic. PaO2 of 70 is OKish. She will survive.
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| Drtweetie
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My answer is heparin. This is PE--immobilized after hip surgery, has v/q mismatch, intubation will not help. Therefore, tx underlying problem! NO other signs or risk factors of fat embolism on exam ie. petechiae, tachypnea, ALOC. Pt had hip surgery, but fat embolism mostly occurs d/t fractures secondary to blunt trauma.
I'm leaning towards PE than fat embolism.
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| dr in trouble
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dr_arc,thrombolytic therapy is CI in any invasive procedure or surgery within 2 wks.so the choice shud be heparin---heparin is good during periods of immobilization to dec the risk of thromboembolism.
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| coolmavs
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Yes, it is the thrombplytic therapy which is contraindicated and the pt is stable for the time being! More imp to prevent future emboli and further deterioration! Infact isnt low dose heparin given as a prophylaxis during hip surgeries! and this dosnt look like fat embolism! No petechiae?
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| DrVirgo
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My final answer is C. Heparin… PE diagnosed by V/Q Scan, patient is stable, and she has no risk for bleeding.. Next Step --> Heparin.
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