peraspera
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A man is admitted to the ER with sudden onset of schortness of breath.
On auscultation- lungs are clear. Chest x-ray is normal. The blood gas is pO2 ( 70mmHg), there is markedly elevated A-a gradient. The patient has a history of severe erosive gastritis. He is started on IV heparin and later developes melena and tachycardia. What is best therapy for this patient?
A. IV H2 blockers
B. Switch to low-molecular weight hepatin
C. Inferior vena cava filter replacement
D. Embolectomy
E. Switch to coumadin
F. IV proton-pump inhibitors
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| dermatology
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F??????
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| Doc750
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Just thinking outloud ...
A . no not first line tx
B . no, if they wanted you to think this was Hep induced thrombosis, the tx is protamine sulfate, not switch to lmwh
c. no, is for recurrent emboli, or those in who anticoag is c/i
d. no/maybe .. but they there should have been a mention of a + doppler finding or v/q scan
e. no ... used for long term/chronic therapy. not acute tx
f. ... Yes, by default ... to control the acid secrtion, slowing the erosion. 
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| Ivonne
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Good question. I am not sure... Definetely this patient needs an IV proton inhibitor but He has an indication for vena cava filter. So I will go for C and awating for the right answer.
[left]Table 4. Indications for a vena caval filter[/left] [left]1. Absolute contraindication to anticoagulation[/left] [left]—CNS hemorrhage[/left] [left]—Overt gastrointestinal bleeding[/left] [left]—Retroperitoneal hemorrhage[/left] [left]—Massive hemoptysis[/left] [left]—Cerebral metastases[/left] [left]—Massive cerebrovascular accident[/left] [left]—CNS trauma[/left] [left]—Significant thrombocytopenia (,50,000/μL)[/left] [left]2. Life-threatening hemorrhage on anticoagulation[/left] [left]3. Failure of adequate anticoagulation[/left] [left]http://bloodjournal.hematologylibrary.org/cgi/reprint/95/12/3669?ck=nck[/left]
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| Kamsi
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F
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| aaroho
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F
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| Dr.D
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F
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| peraspera
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| amkhit
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The pt needs 2 be heparinisd ,hence B
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| sukhs
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D...Unstable patient of pulmonary embolism..
do give us the answer, peraspera
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| starcraftbw
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D
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| peraspera
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right is C. Inferior vena cava filter placement.
The patient has a pulmonary embolus, although IV proton-pump inhibitors are useful, they will not keep pt. from dying of the PE.
A vena cava filter will prevent further emboli to the lungs,( THE BEST therapy for this patient now) , it is indicated either when a pt. has a recurrent embolus while on heparin or when there is a contraindication to heparin ( GI bleeding or intracranial bleed.).
He does not have severe enough disease or hemodynamic instability -embolectomy is for Hemodynamically Unstable.
IV H2 blockers are useless in acute GI bleeding.
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| Ivonne
Find a way or make one
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Hey peraspera love your questions and that kiddy. Where do you get your questions from?
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| starcraftbw
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wow...markedly elevated Aa and low PO2 and they don't treat it.
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| peraspera
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These questions are from IM QBook by Conrad Fischer.
And some from Harrison Self Accessment & Board Review.
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| starcraftbw
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^^^tough question
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