“Lost consciousness on the job…” Case Conclusion December 6, 2012
Posted by Andy Jagoda, MD in: Cardiovascular , trackback
The 49-year-old construction worker, acute coronary syndromes was your primary concern; however, given the patient’s recent history of deep vein thrombosis, a CTPA was ordered to assess for PE. This showed multiple central pulmonary emboli, including a saddle embolism. The exact wording at the end of this preliminary reading was, “clinically correlate if patient still alive.” You performed bedside cardiac ultrasound and saw a dilated right ventricle. Based on these findings, the patient was admitted to the ICU. Approximately 6 hours later, the patient became increasingly dyspneic and tachycardic. A repeat bedside ultrasound showed increased dilatation of the right ventricle. The patient was taken emergently to angiography, where rt-PA was administered into the central pulmonary vasculature. The patient’s hemodynamics improved, as did his symptoms. He was eventually discharged from the hospital on warfarin therapy.
Congratulations to Dr. Cheah, Dr. Bingisser, Dr. Karp, Dr. Pantelis, and Dr. Benavides — this month’s winners of the exclusive discount coupon for Emergency Medicine Practice. For an evidence-based review of the etiology, differential diagnosis, and diagnostic studies for The Emergency Medicine Approach To The Evaluation And Treatment Of Pulmonary Embolism, purchase the Emergency Medicine Practice issue on this topic.