in css PE ,--do we need to wait for ptt result - daany

[ArchivalUser]

before starting heparin.


any input appreciated.

thanks

[ArchivalUser]

I am not sure about ptt, but for sure FOBT

[ArchivalUser]

I do not agree with waiting for ptt or FOBT... what if pt is guaiac positive, are you gonna let him die from a PE? of course not.

If you have a diagnosis of PE, then immediately start hep gtt..

[ArchivalUser]

pt has PE and Recent h/o SAH
what you gonna do?

[ArchivalUser]

that was my doubt too what is he any bleeding or coagula abn???


thanks

anyone

[ArchivalUser]

SAH, then IVC filter, no heparin, for sure.
Please correct me if I am wrong, thanks
Rx heparin
a) AMI, I will do FOBT before start heparin.
b) stroke, look for indications for heparin use
c)PE or DVT, Dx by d-dime(+) plus images(+), Tx heparin after Dx, I will await for PT/PTT/INR if pt has any kind of blood problems in the history, otherwise, I will start heparin and only use PT/PTT/INR(for warfarin) as monitors for dose adjustment and early detect bleeding tendency
any time, pt has bleeding after starting heparin, check platelets if not use LMWH. if pt has history of PUD and now he is bleeding, stop heparin and wafarin, use IVC filter.

[ArchivalUser]

do u use ivc filter or embolectomy?As ivc filter will only prevent future clot formation, no present pe.

[ArchivalUser]

if it si life threatening, it will be more than sob and CP, you may see RHF or RBBB, CRX in this case will be congestive finding, then do embolectomy, you should have hint that clot from carotid or coronary vessels as I reacll, correct me if you or any one disagree. thanks