humbling art medicine
one of our staff grade docs has been unwell for months with chest problems
has caused havoc with our rostering and often berated by colleagues
collapsed early August and was admitted under respiratory team
syncopal but also wheezy and slightly hypoxic
negative d dimer
normal CT Scan
told by senior respiratory physician that the problem was psychological/functional
discharged after some unpleasant encounters with the respiratory specialist who is a very self confident fellow
collapsed ten days later at home
hypoxic, d dimer positive multiple PEs on second CT scan, widespread DVTs both legs on US exam some of which look quite old and organised with recanalisation
lucky to be alive I reckon but still really quite ill and impaired
humbling art medicine
Sad to say I could tell you much worse stories about missed PEs
JohnC
-----Original Message-----
From: Adrian Fogarty [mailto:[log in to unmask]]
Sent: Friday, September 03, 2004 11:38 PM
To: [log in to unmask]
Subject: Re: diagnosis of pulmonary embolism
Funny old world, Craig, most of our locums/students etc are Aussies, Kiwis
and South Africans!
Fascinating case Helen.
AF
P.S. Craig, can you post your likely/unlikely classification?
----- Original Message -----
From: "Craig Ellis" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, September 03, 2004 9:25 AM
Subject: Re: diagnosis of pulmonary embolism
Im amazed some of you wouldnt scan this woman. It must be a southern
hemisphere thing - I certainly would have scanned her.
You all seemed to want to scan my UTI/Ectopic lady last week but not this
lass :-) - by the way she did have an ectopic and also a UTI (heavy e-coli
growth) - she presented 13 days later with a ruptured ectopic and the
complaint is St Elsewhere had failed to diagnose it - and she was completely
symptom free for 10 days after her UTI was treated - midwife didnt arrange a
scan - then severe abdo pain and syncope.
We use Well's Likely / Unlikely risk stratification rather than low, medium
or high and she would have fallen into the likely cat (>4) which is an
urgent CTPA - protocol agreed with radiology - after 10pm anticoagulate and
they do it the next morning.
Craig
Back in NZ from Perth, and in Sunny (but bloody cold) Hawkes Bay with a 90%
English SHO workforce !!
>From: Ayan Sen <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: diagnosis of pulmonary embolism
>Date: Thu, 2 Sep 2004 04:06:09 +0530
>
>You're right,Andy.....precisely the point,do agree about the mortality and
>problems with angio and warfarin...in fact,even angio has missed PE(pleural
>infarcts)....but how do u assess the low probability if no alternative
>diagnosis is definite?that in itself puts 3 point score and a moderate
>probability where d-dimers are not supposed to have any relevance.
>
>Ayan
>
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