On the info you've given us she is definately low risk for TED. The
tachycardia on arrival could be anxiety related, but like Helen I would want
to see this settle prior to discharge - a persistent tachy of 120 would make
me pretty anxious about discharging her without further
observation/investigation - any chance of her ingesting cardioactive drugs?
Best wishes, Bill
----- Original Message -----
From: "Ayan Sen" <[log in to unmask]>
To: "Bill Bailey" <[log in to unmask]>
Sent: Tuesday, August 31, 2004 8:37 PM
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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