08-28-2014, 09:35 AM
25.
A 35-year-old man comes to the emergency department because of a 2-hour history of shortness of breath and left-sided chest pain that is aggravated by deep inspiration. He has no history of trauma, surgery, or illness requiring prolonged bed rest. On physical examination he is now pain-free but he has slight dyspnea. He also has mild tachycardia and slight tenderness to pressure over the left chest wall. Arterial blood gas analysis while breathing room air is shown:
Po2 65 mm Hg
Pco2 25 mm Hg
pH 7.40
Chest x-ray discloses a blunted left costophrenic angle. ECG is normal. Ventilation-perfusion lung scan is reported as "intermediate probability for thromboembolic disease, disclosing a mismatch with one segment showing no perfusion." Doppler ultrasonography of the lower extremities shows deep venous thrombosis. At this time it is most appropriate to initiate therapy with which of the following?
A) Heparin
B) Indomethacin
C) Streptokinase
D) Theophylline
E) Warfarin
A 35-year-old man comes to the emergency department because of a 2-hour history of shortness of breath and left-sided chest pain that is aggravated by deep inspiration. He has no history of trauma, surgery, or illness requiring prolonged bed rest. On physical examination he is now pain-free but he has slight dyspnea. He also has mild tachycardia and slight tenderness to pressure over the left chest wall. Arterial blood gas analysis while breathing room air is shown:
Po2 65 mm Hg
Pco2 25 mm Hg
pH 7.40
Chest x-ray discloses a blunted left costophrenic angle. ECG is normal. Ventilation-perfusion lung scan is reported as "intermediate probability for thromboembolic disease, disclosing a mismatch with one segment showing no perfusion." Doppler ultrasonography of the lower extremities shows deep venous thrombosis. At this time it is most appropriate to initiate therapy with which of the following?
A) Heparin
B) Indomethacin
C) Streptokinase
D) Theophylline
E) Warfarin