Concluded Case

PULMONARY THROMBOEMBOLISM

70/F presented to casualty with Severe respiratory distress along with Sweating for 2hrs.She had also Exertional dysnpoea for last 3days.Intubated and ventilated upon arrival.Known Diabetic and Hypertensive on regular treatment. On presentation - HR -120,BP -80/60mmhg,RR -12/Mt,Spo2 -72%.Chest - Breath sounds diminished,CVS - No murmurs,Pupils - B/l 4mm RTL,GCS - E1M5V1.LVEF - 20% with Global hypokinesia of LAD moreover LAD territory.D-dimer - 10000,Sensitive Trop - I -686,Initial labs report enclosed with Xrsy chest,ECG and CT angio.DIAGNOSIS AND SUGGEST MANAGEMENT AND TREATMENT PLAN?

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Concluded answer
Massive Pulmonary embolism with Severe Hypoxemia in Shock Pulmonary embolism is not disease. Its a complication of some underlying venous thrombosis. Complete history and examination required and workup should be done including antithrombin III, Protein C, protein S, lupus anticoagulant, Homocysteine. Rx Supportive treatment Anticoagulation Thrombolysis Surgical embolectomy
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A case ideally to be treated in ICU settings with emergency intensive care . Positive findings with inference D- Dimer levels are significantly raised indicative of pulmonary embolism . Trop - T is significantly raised indicative of Acute.M.I .Also ECG is indicative of Acute.M.I with arrhythmia. Also Echo is indicative of severely decreased LVEF - 20 % with global ischemia of LAD and LAD territory- again confirming acute M.I . S.urea and creatinine are raised as part of acute kidney compromise due to BP- 80 / 60 . ABG studies are also not favorable with hypokalemia , hypernatremia, increases chloride levels , significantly decreased PO2 , increased PCO2 and alkalosis. Increased ammonia levels again indicative of severe heart failure and a poor prognostic factor. Also a high leukocytosis indicative of septicemia.. So Diagnosis is Acute MI with CCF with pulmonary embolism with acute renal failure with septicemia with hypokalemia and hyponatremia.with alkalosis. Management- Oxygen support with mask . Thrombolysis with ECG monitoring. Maintaining IV line - correction of hypokalemia,hypernatremia, hypotension Monitoring urine output , Parenteral antibiotics- 3rd generation cephalosporins
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Massive Pulmonary embolism with Severe Hypoxemia in Shock Pulmonary embolism is not disease. Its a complication of some underlying venous thrombosis. Complete history and examination required and workup should be done including antithrombin III, Protein C, protein S, lupus anticoagulant, Homocysteine. Rx Supportive treatment Anticoagulation Thrombolysis Surgical embolectomy
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Pulmonary embolism as D dimer high arterial flutter causing Embolism Don't interpretation as MI till CT angio or CAG confirms As ECG showing S1Q3T3 pattern only with atrial flutter Primary thromboembeloctomy if detected in CT angio Need diuretic & Heparanie infusion monitor PT INR Noradrinaline / Dobutamine inotropic support As count is on higher start antibiotics
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
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Pulmonary thromboembolism as d dimer raised Acute MI as Troponin I raised Septicemia as TC high Balance k and amonia level accordingly
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R/o PTE, Do 2D echo to look for valvular pathology, Lower Limb Doppler to r/o DVT
PTE PAH, CCF Rx O2 Thrombolysis Correct Electrolytes ,BP, ,I/O charting
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