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.




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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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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