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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