Case of the day

Pulmonary Embolism

23yeqr old female day 7post natal care (normal delivery bed ridden patient brought to ER with Sudden onset breathlessnes since morning With no c/o fever chest pain convulsions headache Chief Complaints Sudden onset breathlessnes since morning History Day 7 Post natal care Vitals Afebrile Bp 90/60mmhg Rr 24/min Spo2 90 HR118/min Physical Examination RS min basal Crepts Other systems wnl Investigations RAT for covid negative hb 11.2 TLC 14000 Plt 3.40lakh Sr cr 1.9>>>0.9 mg% Sr bili0.8 INR 1.19 PT aPTT wnl D-dimer >10000ng/ml Cpk mb -24 iu/l Ecg sinus tachycardia S1 Q3 T3 rSR in v1 twave inversion in v1-v3 Usg abdo pelvis -no abnormalities except for findings of colitis . Chest xray -slight elevated rt hemidiaphragm CTPA(on day3 ) -partial filling defect in distal right and left main pulmonary artery extending to segmental branches B/L lower limb Doppler -no e/o thrombosis Diagnosis Pulmonary thromboembolism Management Oxygen inhalation On day one with strong suspicion of PE Pt started on inj heparin 80iu/kg iv bolus fb 18mg/kg/hr infusion With Oral anticoagulation.

(Edited)

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Nice presentation, in any susceptible pt with sudden onset dyspnea if u don't keep pulmonary thromboembolism as a possibility u r likely to miss it and may even mistreat or loose that patient, this is a high probability setting, things fit in

Yes sir
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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!

Adv coagulation profile including APLA and homocysteine level. Needs to evaluate for the etiology of pulmonary embolism. May consider rivaroxaban or dabigatran as a anticoagulation therapy.

Post partum pul.embolism.

Post partem pul embolism although rare at 7th day sufficent o2 circulatry shock with iv fluid/plasma expander ecternal cardiac masage for disloging and breaking large central thrombug heparin infusion later anticoagulant for 3 month if anticoagulant contraindicated caval filter can be tried
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