Date:30/09/2004
I agree, but most hospitals seem to have it in their protocols (interested
to see what the NNT is (number needed to test). The same as the abcess that
routinely has a FBC/UE done
Andy Webster
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Alistair Murray
Sent: 06 September 2004 19:46
To: [log in to unmask]
Subject: Re: diagnosis and Rx of pulmonary embolism
A little off the immediate topic but what is the rational behind a
"baseline" coagulation screen. It always gets quoted, but I don't
understand why. The FBC I can rationalise due to heparin induced
thrombocytopenia, the renal profile due to the renal excretion of low
molecular weight heparin, but the use of "screening" coag samples I have
never found useful, especialy in this circumstance. I would only send a
sample if I had reason or if I was following it on an ongoing basis eg
obvious liver disease or a history suggestive of coagulopathy.
Am I being too harsh?
Alistair Murray
Emergency Medicine SpR
Dublin
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Ayan Sen
Sent: 06 September 2004 19:34
To: [log in to unmask]
Subject: Re: diagnosis and Rx of pulmonary embolism
In an ideal circumstance,as an emergency physician,i would like to be
pro-active and investigate her under our care.(that would include ultrasound
for DVT as well).Once a diagnosis of pulmonary embolism is entertained,i
would start her on treatment dose of Enoxaparin 1mg/kg BD,get the baseline
CBC,Plt,PT/INR,Chem and admit her in a medical unit where Warfarin (5 mg or
10 mg as per validated protocol) regime should be planned and extensive
evaluation for thrombophilia should be undertaken considering absence of any
overt risk factor.
If however,a scan is not possibly immediately,due to patient coming in in
the middle of night(though a bit of aggression from radiologists would be
highly welcome!),and a moderate-high probability of PE exists,i would still
administer treatment dose of Enoxaparin,after informed consent, with all the
other bloods and prepare for scan in the morning.
Ayan Sen
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