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Old 06-07-2011
USMLE-Syndrome's Avatar
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Question Wrong Q in usmle consult!

A 33-year-old male is 2 days postoperative from surgery to repair a fractured femur when the nurse taking care of him reports that suddenly he began to “breathe hard” and complain of chest pain and shortness of breath. On exam the patient is diaphoretic and pale. Vital signs show heart rate 133 beats/min, respiratory rate 33 breaths/ min, blood pressure 90/40, and oxygen (O2) saturation 83% on room air. His O2 saturation is increased to 90% using a nonrebreather mask and he is given a 1 L bolus of normal saline. What is the definitive treatment for this acute condition?

Answer Choices Correct answer Your answer
A. Cardioversion
B. Heparin drip
C. Intubation
D. Thrombolytics
E. Warfarin

Option D (Thrombolytics) is correct. This patient has a PE secondary to the surgery on his leg. Thrombolytic therapy is indicated in PE when there is hemodynamic compromise, severe hypoxemia, right ventricular dysfunction, or substantial filling defect on ventilation/perfusion scan. In this patient, who is hypotensive and hypoxic, thrombolytic therapy should be initiated.

Option A (Cardioversion) is incorrect. Cardioversion would be indicated in an unstable patient who is having an abnormal rhythm such as atrial fibrillation or ventricular tachycardia. Cardioversion is not used in PE.

Option B (Heparin drip) is incorrect. A heparin drip would be the treatment of choice for those patients with pulmonary emboli who are stable and need anticoagulation. In a patient who is in extremis, thrombolytics or a embolectomy (surgical removal of the clot) are necessary.

Option C (Intubation) is incorrect. Intubation may be necessary in some cases, but this is not the definitive treatment. This patient is no longer hypoxic on O2 supplementation and is in need of a treatment to remove/lyse the clot causing the hemodynamic compromise.

Option E (Warfarin) is incorrect. Warfarin is the chronic therapy for deep venous thrombosis and those patients who have had a pulmonary embolism (PE), but it does not play a role in acute treatment.

As I know that Thrombolysis is CI in surgery <14 days so mx to this unstable PE patient is embolectomy (removal the clot) I remember there is question in UW like this one
am I right?
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Old 06-08-2011
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Embolectomy if it was given in the options would have been the correct answer.. But its not... So we go for the next probable one... Which is thrombolytics.. yes... Your arguement is correct.. But in such cases we have to see the benefits too.. and when the benefits outweighs the risk then we should select that option
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Old 06-08-2011
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emobolectmy is superior, but the guy is dying, he is hemodyn unstable, you gotta lyse the clot or he dies, worry about his bleeding later ... he will pay elvis a visit personally in case the clot wasnt removed
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Cardiology-, Emergency-Medicine, Pulmonology-, USMLEConsult

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