Adrian Fogarty <[log in to unmask]>typed
> Attachment 1: ,text/html
> I would have thought the latter...clearly.
> Adrian Fogarty
> Ayan Sen <[log in to unmask]> wrote:
> 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?
I don't think I'd be happy sending anyone (adult) home with a pulse of 120.
I still have a niggling suspicion that this girl may be on the O/C pill.
(Many young women do not consider this to be medication!)
If she is pain-free, I would want to explain her tachycardia; if she
still has pain, I would wish to review after analgesia.
(I still wonder if she's popped a tiny pneumothorax, though)
--
Helen D. Vecht: [log in to unmask]
Edgware.
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