DrVirgo
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In the case of sudden SOB, iwth clear lung sounds, obese patient with OCP use, dyspnea, tachycardia, what is the NEXT BEST STEP?
A. CXR and ABG
B. EKG
C. V/Q Scan
D. Start Heparin
E. Observation
Please explain.
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| Justice
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B. EKG
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| sandra
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a
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| DrVirgo
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A is right
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| guangyu
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A
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| DrVirgo
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WHY NOT C) V/Q Scan?
When would V/Q Scan be the right answer?
Do we ALWAYS have to CXR and ABG before V/Q Scan?
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| GOGETA
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Also when do you choose ultrasound for the legs?
But in this case
EKG first then Cxray and then VQ scan SOME people are talking that is Spiral CT.
Also if you have low suspiction you can do and do not forget D dimers is they are negative the patient does not have PE, if is + it does not mean anything
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| liliaeliz
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IN THIS CASE YOU CHOOSE ABC CXR LOOKING FOR PULM. DISEASE HIPOXEMIA etc.
IF THEY WANT THAT YOU CHOOSE V-Q IN THE Q ( PTE HAS THE SAME AND NORMAL C XR ,HIPOXEMIA)
ALGOR. C XR ABC ---VQ INCONCL. ---VENOUS U.S OR ANGIOTAC .---ANGIOGHRAM
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| arlete
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If the patient is having chest pain, EKG is done first. Most PE cases present with CP, but this one says dyspnea only.
If they ask the best single test, it's the V/Q scan.
If they ask the gold standard test, it's the angiogram.
Remember you can order D-dimers too, if it's negative, it virtually exclude PE as a possible diagnosis.
I trink US of the legs is for a posterior investigation.
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| steppingsam
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In the case of sudden SOB, with clear lung sounds, obese patient with OCP use, dyspnea, tachycardia,
A. CXR and ABG
CXR to rule out the differentials like Puemonia, Pueumothorax, plueral effusion, asthma etc.
ABG will show: Tacchypnea (Alkalosis), Hypoxia, Hypocarbia and Increase in A-a gradiant.
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| peter90036
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from the presented words (no chest pain - thus no ecg)
is it possible another disease? yes. in practice probably do CXR to r/o other lung dz.
algorithm says
whats probability - Wells criteria
si/s dvt: leg pain, swelling etc = 3 points
an alternate diagnosis is less likely than PE = 3points
HR>100 = 1.5
immobilization/surgery in previous 4wks = 1.5
previous PE/DVT = 1.5
hemoptysis = 1
malignancy = 1
high probability = score > 4
---> imaging:
--------------> CT (not all institution can do, not in renal dz or contrast-iodine allergy)
--------------> VQ
low probability = score <4 --> DDimer
liliaeliz said it: if they want you to pick VQ scan they would've put CXR results in the stem.
i would thus pick CXR to r/o other lung dz.
Edited by peter90036 on 03/17/08 - 07:12 PM
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| peter90036
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heh, just found this:
NEJM Volume 358:1037-1052 March 6, 2008 Number 10
Acute Pulmonary Embolism
clinical suspicion:
- low/moderate ---> elisa DDimer = Norm=no tx // DDimer = abnormal ----> CXR
- high -------------------------------- consider start tx ------------------------------> CXR
CXR abnormal ---> chest CT arteriography
CXR normal ------> CT or VQ
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| Eagle_303
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First of all of chest X-Ray
It rules out some lung pathologies like pneumothorax or pneumonia and pulmonary edema (Cardiac and non cardiac)
Then you can do D-dimer and so on
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