ccs question about pulmonary embolism - michellejohn1234

[ArchivalUser]

hey guys..was wondering if someone could clear my doubts about when in the ccs sequence to use heparin..if the pt comes in with sob and chest pain and we are suspecting pulm emb. After we have run our er protocol and after we order a cxr when we goto results of cxr and see that it is clear and results of d dimers are elevated do we order spiral ct and heparin at the same time or do we order spiral ct wait for the result then order heparin..im a little confused because student consult says to wait for the results but i always thought u go straight to tx. In high probability pulm. Embolism..any thoughts?

[ArchivalUser]

I would order VQ (or spiral CT) and heparin at the same time. If there is a high clinical likelihood, you don't wait.

[ArchivalUser]

If patient is predispose to risk fac and high clinical suspicion with high probability...always heparin first then VQ scan

[ArchivalUser]

thanks guys..