Kamsi
Forum Guru
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A 32 -year -old woman comes to the Emergency Department complaining of sudden onset of severe shortness of
breath that began four hours ago. She also has a nonproductive cough and right -sided chest pain that worsens with
inspiration. She denies having fever, coughing up blood, wheezing, palpitations, leg pain, swelling of the lower
extremities or any recent travel. Past medical history reveals appendectomy at age 15. Her medication include birth
control pills and over -the -counter vitamins. Her family history is: Father, age 65, has had diabetes for 20 years;
mother, age 58, has coronary artery disease. She has never been pregnant, drinks alcohol socially and does not
smoke. Her vital signs are: T 99 F (38C), BP 110/70 mmHg, PR 130/min and RR 30/min. Pulse oximetry showed
85% on 6 lit oxygen. Physical examination shows a slightly obese, white woman in acute distress. She is alert and
cooperative without cyanosis or jaundice. The rest of the physical examination is normal. What is the most appropriate
next step in this patient's management?
A. EKG
B. Echocardiogram
C. V/Q Scan
D. Angiogram
E. Doppler ultrasound of lower extremities
F. Chest -x ray and arterial blood gases
G. Spiral CT - Scan
H. D -dimer
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| docfor99
Forum Senior
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v/q scan....pul embolism?
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| Doc750
transfer:step 3 prison
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the stem doesn't give any indication of a cause of PE (ie recent flight, etc), other then the use of OCPs.
She does have an acute cough, and pleuritic chest pain .. indicating possible infection
and she had a + family history of CAD, and DM.
I'd go with A and rule out MI first.
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| gordon
Forum Newbie
Topics: 5
Posts: 27
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F.
Any suspected PE you should have measurements in order as follows:
1. Chest x-ray
2. ABG
3. V/Q scan
4. Start treatment as soon as possible.
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| spmvj
Forum Newbie
Topics: 3
Posts: 36
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F.CxR&ABG.
i think when a patient come to ER we do the general investigations first &then we'll go for specific investigations.After taking CXR&ABG we can do V/Q scan which is principal test in suspected pulmonary thromboembolism.
EKG shows sinus tachycardia with right ventricular strain pattern which is not diagnostic.
Echo is useful in patients with hemodynamic compromise.
Angiogram is done in equivocal cases.
If the patient has symptoms of DVT we can do doppler of lower extremities.
Spiral CT is highly specific but not very sensitive
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| doc_clotaire
Forum Guru
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agree with F
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| dermatology
Forum Elite
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it looks like shes got pul embolism .... sudden onset of severe sob , right sided chest pain RR increased .....
first investigation if pul embolism suspected V/Q scan .....if negative Pul Embolism ruled out .... if positive immediate start treatment ... if inconclusive ---> go for venous USG for DVT and Ct angiography for large embolism
if both negative ----> than finally pul angiography ....
patient doesnt have classic signs of MI to do ECG ..
my answer is V/Q scan
Kamsi wats the answer?????
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| starcraftbw
Forum Senior
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I'll do EKG first to r/o MI --> ABG
A.
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| elitoki
Forum Guru
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Chest pain that increase with respiration...
I think next appropiate step should be CXR before any other study.
F
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| Dr.D
Forum Senior
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CXR & ABG first, then V/Q scan, RX. She is taking ocp.
Answer is F
kamsi, what was the answer?
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| kpmle2
Forum Guru
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F. Chest -x ray and arterial blood gases
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| Justice
PGY-I, now officially
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F is useless as the Pt is already on oxygen... What pathognomonic ABG you want to see?
I guess EKG should be done here.
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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F
In PE this is d sequence for treatment given in d answer
a Chest X-ray
b ABG
c EKG
D V/ Q
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