next best step in the management - okt3

[ArchivalUser]

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

[ArchivalUser]

E.

[ArchivalUser]

aa

[ArchivalUser]

AAZ, why E
sujji, why A?

[ArchivalUser]

eee

[ArchivalUser]

i think in this case it should be iv heparin and then we go to investigate more
he is at hiighy risk for PE , AND he is tachycardic , tachypnic , and there is evidence of hypoxemia , so the porbability is high

[ArchivalUser]

heparin

[ArchivalUser]

I suspect pulmonary embolism and we shd start heparin and oxygen before confirming diagnosis if concern abt pul embolism.

[ArchivalUser]

A 35 year old white wmoan comes to the ER complaining of difficulty breathing that started suddenly several hours ago. She has never had such symptoms before. Her past medical history is significant of rheumatiod arthritis. Her current medications include naproxen, and an oral contraceptive. She smokes 1 and a half packs a day, but does not consume alcohol. Her blood pressure is 110/70 mmHg and her HR is 105/min. Lungs are clear on auscultation. EKG and chest x-ray are normal. Ventilation/perfusion scan was performed, but the results were inconclusive.

What is the best next step in the management of this patient?

A. Pulmonary angiography
B. Pulmonary function tests
C. Venous ultrasonography
D. Contrast phlebography
E. Transesophageal echocardiography
F. Start treatment with heparin

[ArchivalUser]

F?