Author: Leon Wood / Editor: Thomas MacMahon / Reviewer: Emer Kidney / Codes: CC3, CC4, CP2, ResC6, SLO3 / Published: 02/09/2022
An 80-year-old woman is next to be seen. She arrived in the UK 2 days ago, after a flight from Singapore. She had shortness of breath on minimal exertion, with dizziness and near collapse after climbing stairs which is very unusual for her.
She has no chest pain, fevers or flu-like symptoms. She is a non-smoker and has a background medical history of hypertension. Her only regular medication is nifedipine. On your examination, she is alert and pain free.
Her vital signs show a heart rate of 45, blood pressure of 124/67mmHg, temperature of 35.6oC, respiratory rate of 21 and oxygen saturations of 95% on 2 litres. She has no murmurs nor visible JVP. She has crackles at both lung bases. Her calves are non-tender and her abdominal examination is unremarkable.
10 responses
I Knew about age adjusted D-dimer, had a patient with chest pain, age more than 50, D-dimer was 450 and discussed with my consultant who suggested CTPA and the result was that he has a PE in a segmental branch of the Right pulomnary artery. I think we will miss these cases if we use the age-adjusted D-dimer
I think the ddimer is a useless test, hope one day we can find proper and safer way to think about PE other than the Wells score and the ddimer, And to take a safe decision when we give the anticoagulant before doing the CTPA.
Nice case. In Q3- I agree we shoud refer to cardiology. Should we start external pacing now rather than wait?
Interesting case that highlights the effect of type 1 bias.
Good case. interesting one
intresting case
Thanks
Very useful and interesting case.
Excellent case. In essence, think outside the box. Recent travel though informative was a red herring eventually.
Great Revision