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Pulmonary Embolism - drdepa00
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09-19-2006, 06:10 PM
if cxr is normal u should always do an abg . it will give u hypoxiemia . if it is not hypoxia it is not pulmonary embolism. low pa02 is most linked to pulmonary embolism. so u have to do the abg, before u proceed to the v/q scan
09-19-2006, 07:23 PM
hi airmax drdepa00 and mital82,
1st step is always ekg and cxr as we ro other causes completely agree with that but after that according to UW we should straight away proceed to V/Q scan as ABGs wont reveal the diagnosis. If u guys have done UW please recheck it. Because i too thought ABGs shud be before V/Q. Please correct me if I and the explanation given in UW are wrong
09-20-2006, 07:49 AM
Conclusion.......
When we have a pt who is anxious and diaphoretic has tachcardia with prominent neck veins and low CVP we know he has PE. First we do ABG--to rule out Hypoxemia and Hypocapnia(if they are not there then it is not PE) Chest X-Ray comes Next Definitive test--V/Q scan Gold Standard--Pulmonary Angiogram(Rarely done) Same like what Usmle20 wrote on the top. I think we have to look at the question how they put it and answer. Let me know if this is ok.
09-20-2006, 07:57 AM
Hi guys,
Looks like this PE diagnosis is creating lot of confusions In the hospital where I work it goes like this..... First you diagnose PE by pts increased rr and pulse and then neck veins distended and all that.... Till then pt will have a nonrebreather mask on his face breathing 100%o2 bythen ABG will be taken chest Xray and EKG taken If still doubt then V/Q scan. I havent seen many pt going for V/Q scan Heparin will allready started by then. So this it in the hospitals I work as a RT. Thx.
09-20-2006, 01:53 PM
hey i m sorry mital it can be either normal or low pao2
this is frm cmdt 2006 Arterial blood gases usually reveal acute respiratory alkalosis due to hyperventilation. The arterial PO2 and the alveolar-arterial oxygen difference (A“a“DO2) are most often abnormal in patients with pulmonary thromboembolism compared with healthy, age-matched controls. However, arterial blood gases are not diagnostic: among patients who presented for evaluation in the PIOPED study, neither the PO2 nor the A“a“DO2 differentiated between those with and those without pulmonary emboli. Profound hypoxia with a normal chest radiograph in the absence of preexisting lung disease is highly suspicious for pulmonary thromboembolism. its true if we hav low paO2 we suspect PE first but they are never diagnostic...
09-20-2006, 02:05 PM
By the way usmle20,
you would do the Spiral CT before the Angiogram. Angiogram is too expensive and is rarely ever done.
10-02-2006, 08:10 AM
dredepa, you're right..
There's a typo in my post...Anticoag till PTT is 1.5 times normal.. (NOT PT)..
10-14-2006, 07:59 AM
Hey Usmle 20, why do you check PTT, if you give warfarin for 6 months. We check INR - warfarin right?
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