SOB

Question 1

What are the new PERC rules to rule out pulmonary embolus

Answer 1

Do wells first-If Low risk then do PERC

• Age <50
• Satting >94%
• Pulse <100
• No prior PE or DVT
• No recent surgery or trauma
• No hemoptysis
• No estrogen use
• No leg swelling

Question 2

Wells criteria

Answer 2

• DVT
• HR >100
• Imobilization for more than 3 days
• Surgery in the past 4 weeks
• Previous PE/DVT
• Hemoptysis
• PE most likely diagnosis
• Malignancy with treatment discussions in the past 6 months

Question 3

When to use a years score

Answer 3

Pregnant patients and suspecting PE

Question 4

Years rules

Answer 4

Any of:

1. DVT
2. Hemoptysis
3. PE most likely

Then D Dimer cut off <500
If none of the above D Dimer cut off <1000

Question 5

What tests would you do for SOB

Answer 5

ECG
Echocardiogram
Troponin 
BNP 
pH 
PaO2
CXR
PFT
CT chest if no clear diagnosis

Question 6

List three life threatening Dx of SOB

Answer 6

Foreign body
Anaphylaxix
Pneumothorax

Question 7

Someone comes in with Pneumo. It is unilateral, large, and spontaneous. What do you do

Answer 7

Observe for 4 hours, repeat x -ray, discharge if stable

Don’t put in drain

Question 8

List 7 non resp or cardiac causes of dyspnea

Answer 8

1. Anxiety
2. Altitude
3. Thyroid
4. GERD
5. Deconditioning
6. Anemia
7. Abdominal mass
8. Allergy

Question 9

What would you do in office for someone with SOB (Assessment wise)

Answer 9

Vitals (HR, SpO2, RR, BP)
Home or exertional Pulse ox
Peak flow 
Resp exam 
CV exam 
ENT exam including thyroid