Pulmonary Embolism
Medgeeks with Andrew Reid
Medgeeks
4.8 • 997 Ratings
🗓️ 6 September 2018
⏱️ 9 minutes
🧾️ Download transcript
Summary
As you're working in the emergency room, you're asked to see a 62 year old female. She has a past medical history significant for morbid obesity (BMI 43).
She fell three weeks ago and fractured her right tibia, which required a cast, and has been not been mobile since.
She developed shortness of breath two weeks ago which has worsened to the point where she can't even put her clothes on without becoming symptomatic.
Her right leg has also become increasingly swollen and painful. She denies fever, syncope, cough, hemoptysis, or chest pain.
Vitals:BP: 132/84, Pulse: 118 bpm, Temp: 98.6 F, O2 sats: 86% on room air.
3L nasal canula was required to keep her sats at 96%.
On todays podcast, Zach is going to walk you through this patient case presentation.
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Transcript
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| 0:00.0 | Welcome back team. |
| 0:01.5 | Zach here for med geeks. |
| 0:03.0 | We're hopping right into a case. |
| 0:05.0 | So you're working in the emergency room and you're asked to see a 62 year old female |
| 0:10.0 | with the past medical history significant for morbid obesity. |
| 0:14.3 | She has a BMI of 43. |
| 0:16.6 | She fell three weeks ago, had a fracture of her right tibia requiring caste, and she's been a mobile since. She developed |
| 0:24.7 | shortness of breath about two weeks ago which has worsened to the point |
| 0:28.2 | where she can't even put her clothes on without becoming symptomatic. She |
| 0:32.4 | also notes that her right leg has become increasingly swollen and painful. |
| 0:37.0 | She denies fevers, syncopi, cough, homopesis, chest pain. Vitals reveal no fever, some tachycardia to 118. |
| 0:48.0 | BP is 132 over 84. |
| 0:51.0 | Oxygen saturations where 86% on room air on arrival, and then required 3 liters of |
| 0:57.2 | nasal cannula to keep the saturation of 96%. |
| 1:01.8 | On exam, she's awake, appears to Kipnick, has clear lung sounds. |
| 1:07.0 | So let's pause right here. |
| 1:10.0 | What's on your differential? |
| 1:12.0 | I want you to think of five diagnoses. All right go |
| 1:17.7 | So here's what I thought of. I came up with pneumonia, pneumothorax, acute heart failure, acute coronary syndrome, and pulmonary |
| 1:27.4 | embolism. All possible diagnoses. However, what is highest on your differential, given her risk factors, clinical |
| 1:36.4 | presentation, and vitals? Well, if you're thinking pulmonary embolism, that's what I'm thinking. So when it comes to |
| 1:44.2 | working up a patient for possible pulmonary embolism, you have to think about the |
... |
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