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|Case #2 Calcium
|Case #3 Calcium
|Case #4 Glucose
|Case #5 Shakes
|Case #6 Weakness
|Case #7 Headache
|Case #8 Weakness
|Case #9 Weakness
|Case #10 Weakness
|Case #11 Weak face
|Case #12 Weak eyes
|Case #13 Shakes
|Case #14 Confusion
|Case #15 Headache
|Case #16 Breathless
|Case #17 Unconscious
|Case #18 Breathless
|Case #19 Weakness
|Case #20 Breathless
A 77-year-old lady has been admitted with a fractured left pubic ramus. She has had an uneventful admission and has now been in for 7 days but is finding it difficult to mobilise. You are asked to see her as she has suddenly become short of breath. She is a non-smoker. She has no chest pain. Her BP is 11/80 mmHg. The nurses tell you that her oxygen saturation is 82% and you advise them to increase her oxygen to 15 L/min (No history of Asthma/COPD) and to get an ECG and ensure she has venous access and you tell them you will be there immediately.
1. What are your suspicions as you hurry to see her. What is the differential of acute breathlessness in this setting
2. What are the issues to assess
3. YOu send some bloods. Is a D dimer useful
4. What will you do now
5. The tests is positive - what is next
6. If the patient had had a recent subdural haemorrhage what alternative to anticoagulation might you consider
7. If the patient had been shocked with low BP what might you have done differently
8. If the patient had been 32 years old and pregnant with a fracture what would you have done differently
9. Question
10. Question
References
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Case #20 Breathless
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It is reasonable to do and many will also send a troponin but this is highly likely to be a PE and needs a CTPA. A CXR is unlikely to be helpful as the diagnosis is quite certain. The CT will look at lung parenchyma.
The CTPA shows bilateral segmental PE
An IVC filter is inserted for several weeks until bleeding risk falls and anticoagulation can be restarted. They are then removed. They will not help this PE but will help to prevent further.
One would have wished for supporting evidence for the diagnosis either with an echocardiogram or the CTPA and if confirmed then Thrombolysis would be considered depending on bleeding risk.
The diagnostic test would have been a USS of the left leg and if a clot was seen then anticoagulation started on that basis. A CXR (fetal shielding) would be done to exclude other diagnoses. And if still unclear then a CTPA with shielding of the fetus might be considered. The fetus is not the concerned with radiation as can be shielded. It is radiation to the female pregnant breast with concerns of breast cancer later in life.
Answer
Answer