l******g
发帖数: 278 | 1 Three days after undergoing colectomy for colon cancer, a 77-year-old
woman has the sudden onset of severe shortness of breath. She says she
cannot catch her breath. Current medications include subcutaneous heparin
and patient-controlled morphine. Her temperature is 37°C (98.6°F), pulse
is 140/min, respirations are 28/min, and blood pressure is 110/60 mm Hg.
Pulse oximetry on room air shows an oxygen saturation of 89%. Breath sounds
are decreased on the right. Abdominal examination shows an intact surgical
incision with no erythema or discharge. Arterial blood gas analysis shows:
pH
7.38
Pco2
23 mm Hg
Po2
55 mm Hg
A chest x-ray shows atelectasis at both lung bases. An ECG shows nonspecific
ST-T wave changes. In addition to oxygen therapy, which of the following is
the most appropriate next step in management?
A
) Spiral CT scan of the chest
B
) Oral warfarin therapy
C
) Intravenous administration of a recombinant tissue plasminogen
activator
D
) Pulmonary angiography
E
) Placement of a vena cava filter |
q**d
发帖数: 109 | |
z**********4
发帖数: 467 | 3 选A啦，要排除Pulmonary embolism非常重要，V/Q scan AND Spiral CT are both
valid choices. But spiral CTs are more and more used. |
l******g
发帖数: 278 | 4 How likely does patient suffer PE when he is on heparin? |
l*******d
发帖数: 449 | 5 选A啦，要排除Pulmonary embolism非常重要 although patient is on heparin. |
z**********4
发帖数: 467 | 6 Suboptimal use of Heparin. Check the coag panel. |
