P.E

Question 1

A 60-year-old male patient POD3 post sigmoid colectomy for cancer. He
has tachycardia, tachypnea and fever. O/E pulse is 110, Po2 90% on room
air, RR. 24 & BP: 110/70.

Q1. What is your DD?

Answer 1

1. PE, anastmoic leakage, pulmonary Edema, sepsis

Question 2

Q2. Why is PE suspected ?

Answer 2

2. major surgery and cancer, immobile for the past days , tachycardia, O2 saturation

Question 3

Q3. How to approach this patient ?

Answer 3

3. CCRISP, inform my senior. MENTION «ABG», LFT

Question 4

Showing the following ABG :
PH 7.49 - Po2 = 8 - Pco2 = 3.8 - Hco3 = 24 - Base excess = 1.2
Q4. What is your diagnosis ?

Answer 4

4. uncompensated resp. Alkalosis

Question 4

Q5. Why do you think the patient have respiratory alkalosis ?

Answer 4

5. Pt is tachyapnic and there is wash out of the CO2.

Question 5

Given the following ECG :

Q6. What is your diagnosis ?

Answer 5

6. sinus tachycardia, large s wave in lead I and Q wave Lead III and inverted t in lead III.

Question 5

Q7. What is the golden standard investigation of PE ?

Answer 5

7. CTPA

Question 6

Q8. Comment on the following CTPA ?

Answer 6

8. Filling defect in pulmonary artery. large embolus on left pulmonary artery.

Question 7

Q9. Pathogenesis of clot formation ?

Answer 7

9. Stagnation of blood flow — platelets aggregation – realse tissue fx from platelets like serotonin – more platelets aggregation and activaioyof coagulation system .

Question 8

Q10. If you are scrubbed in OT & the word nurse informed you that your patient is suspected to have PE, what will you do?

Answer 8

10. Inform your senior/ Send someone else

Question 8

Q11. Would you speak about Well’s criteria.

Answer 8

11. Criteria for Dx of pulmonary embolism depends on clinical signs and symptoms of DVT / PE is first suspected dx or equally likely/ HR>100 / immobilisation for the last three days / surgery post 4 wks / previously dx PE OR DVT. / Hemoptysis.