It's the old GP again.
My mother died of a PE. Her only sign was a resting tachycardia. They
didn't do dimmers in those days but her CXR, ECG, PEFR and pulse
oximetry were all normal.
Sometimes I think a tiny voice - a ghost of Hippocrates - whispers in
your ear "don't send this one home". You'll never convince me not to
listen to my gut anxieties - and we should hone this in the juniors -
not disparage it.
Vic Calland
-----Original Message-----
From: [log in to unmask]
[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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