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*  resp7
 #134190  
  dolly123 - 10/31/06 10:33
 
 

A 45-year-old Caucasian male comes to the emergency room complaining of shortness of breath that began 3 hours ago. He also has a nonproductive cough, slight fever and right-sided chest pain that worsens with inspiration. He denies coughing up blood, wheezing, palpitations, leg pain or swelling of lower extremities. He recently had a trip to Singapore. Past medical history reveals hypertension for 8 years, and diabetes mellitus for 4 years. His medication includes captopril and glyburide. He is allergic to penicillin. He doesnot smoke. He drinks alcohol occasionally. His vital signs are T: 101 F (38.3C), BP: 115/70 mmHg, PR: 128/min, and RR: 32/min. Physical examination shows slightly obese white man in acute distress. He is alert and cooperative without any cyanosis or jaundice. His physical examination reveals slightly displaced apex beat with loud S 4. Chest-x ray shows mild cardiomegaly. EKG shows sinus tachycardia and left ventricle hypertrophy; no acute ST-T changes seen. His Arterial Blood Gases shows: pH 7.52, pCO2 30, pO2 60, and 86% O2 saturation on room air. He is started on oxygen. What is the next best step in the management of this patient?


A. Ventilation perfusion scan
B. Pulmonary angiogram
C. Doppler of lower legs
D. Spiral CT scan of chest
E. Start heparin
F. Give thrombolytic therapy with t-PA
G. Placement of inferior vena cava filter
H. Embolectomy
I. Cardiac enzymes
J. PTCA
K. Echocardiogram


 
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* Re: resp7
#537408
  airmax - 10/31/06 10:35
 
  E. Start heparin  
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* Re: resp7
#537414
  malak - 10/31/06 10:40
 
  E. Start heparin  
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* Re: resp7
#537613
  internalmed - 10/31/06 11:59
 
  ONCE THE DIAGNOSIS IS MADE WE CAN START HEPARIN RIGHTAWAY,NO NEED TO WAIT
UNTIL VQ SCAN ETC.RESP ALC,LOW CO2 LOW O2 EKG FINDINGS SUGGEST PEMBOLISM
 
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* Re: resp7
#537619
  ben - 10/31/06 12:02
 
  start heparin . And the reason we would not go for V/Q scan is b/c Cxr and ABG have r/o other causes already so no need to confrim our suspicion of PE as all the Hx also points to Dx of PE, lus they did not aslk what test would confrim the Dx of PE. So next is to go for Rx  
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