Date:31/08/2004
Have you got a another likely diagnosis in mind?? Apart from atypical chest
pain. Could argue either way, then it's down to clinical intuition.
Could argue low risk, but return if increasing pain or breathlessness
She doesn't get a clear diagnosis, may end up with a PE as even in the low
risk group some will end up having PE.
Andy Webster
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Ayan Sen
Sent: 31 August 2004 20:37
To: [log in to unmask]
Subject: diagnosis of pulmonary embolism
Hi all,
I would like the list's opinion on this scenario.
An 18 year old girl comes to A/E with sudden onset of pleuritic chest
pain,sharp,severe intensity,non-radiating lasting for an hour and
persisting,which she developed while working in a pub,no past history of
similar episode though she suffers from asthma,RR=18/min,sats 99% on
air,PR=120/min,BP=118/70,did report that she felt faint for a few minutes
before being brought to hospital,chest clear on
examination,ECG=Non-diagnostic,C-Xray=normal,no thromboembolic risk factors
present.A quantitative d-dimer was within normal limits.
If you incorporate Well's criteria,where would you place this girl?
If PE more likely than alternative diagnosis is considered,she moves on to
'moderate probability' with a score of 4.5,and d-dimers are probably of no
use.She should have a V/Q scan.Would that constitute diagnostic overkill?Or
should we place her in 'low probability' considering the atypical history
and absence of risk factors and send home feeling smug after normal d-dimers
relying on a high negative predictive value?
Ayan Sen
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