#Clinical_case_answer_31
1⃣ Risk factors:
1) Stasis (bed rest, immobilization)
2) Hypercoagulopathy (Trauma, estrogen)
3) Endothelial injury (trauma)
4) Age > 40
5) Lower extremities fracture
6) Brain injury
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2⃣ Differential diagnosis:
1) Pulmonary embolism
2) Pneumothorax
3) Mucus plugging
4) Cardiac ischemia
5) Fluid overload
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3⃣ Most likely diagnosis:
💠 Pulmonary embolism
🔷 Discussion:
Most PEs occur when a thrombus breaks free from the endothelial wall, traveling through the right heart, and lodging in the pulmonary artery. PE causes ventilation/perfusion mismatching, increased pulmonary vascular resistance, and cytokine mediated pulmonary vasoconstriction. Symptoms depend on the degree of pulmonary arterial obstruction, severity of the inflammatory response, and the patient's physiological reserve. Most patients have dyspnea, while some patients have hypoxemia. At times, extravasation of blood into the alveoli can produce pleuritic chest pain, cough, or hemoptysis.
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4⃣ Priorities in management:
📌 Determine adequecy of oxygen and ventilation
📌 Airway protection
📌 High-flow oxygen
📌 ECG
⚠️ T-wave inversions in lead V1 and V2 may be present on EKG and are 99% specific for PE.
📌 Contrast-enhanced Abdominal and pelvic CTscan
📌 Anticoagulant therapy
⚠️ Empiric anticoagulation should be considered in high-risk patients without significant bleeding risks. Treatment with either unfractionated heparin or LMWH is acceptable. Hemodynamically unstable patients with large central PEs can be considered for catheter-directed therapy such as catheter-directed thrombolytic therapy or catheter-directed mechanical clot disruption therapy.
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✅ Final diagnosis:
#Pulmonary_embolism
1⃣ Risk factors:
1) Stasis (bed rest, immobilization)
2) Hypercoagulopathy (Trauma, estrogen)
3) Endothelial injury (trauma)
4) Age > 40
5) Lower extremities fracture
6) Brain injury
➖➖➖➖➖➖➖➖➖➖
2⃣ Differential diagnosis:
1) Pulmonary embolism
2) Pneumothorax
3) Mucus plugging
4) Cardiac ischemia
5) Fluid overload
➖➖➖➖➖➖➖➖➖➖
3⃣ Most likely diagnosis:
💠 Pulmonary embolism
🔷 Discussion:
Most PEs occur when a thrombus breaks free from the endothelial wall, traveling through the right heart, and lodging in the pulmonary artery. PE causes ventilation/perfusion mismatching, increased pulmonary vascular resistance, and cytokine mediated pulmonary vasoconstriction. Symptoms depend on the degree of pulmonary arterial obstruction, severity of the inflammatory response, and the patient's physiological reserve. Most patients have dyspnea, while some patients have hypoxemia. At times, extravasation of blood into the alveoli can produce pleuritic chest pain, cough, or hemoptysis.
➖➖➖➖➖➖➖➖➖➖
4⃣ Priorities in management:
📌 Determine adequecy of oxygen and ventilation
📌 Airway protection
📌 High-flow oxygen
📌 ECG
⚠️ T-wave inversions in lead V1 and V2 may be present on EKG and are 99% specific for PE.
📌 Contrast-enhanced Abdominal and pelvic CTscan
📌 Anticoagulant therapy
⚠️ Empiric anticoagulation should be considered in high-risk patients without significant bleeding risks. Treatment with either unfractionated heparin or LMWH is acceptable. Hemodynamically unstable patients with large central PEs can be considered for catheter-directed therapy such as catheter-directed thrombolytic therapy or catheter-directed mechanical clot disruption therapy.
➖➖➖➖➖➖➖➖➖➖
✅ Final diagnosis:
#Pulmonary_embolism
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#Clinical_case_34
A 72-year old man has admitted to hospital with 10 days history of progressive confusion and unsteadiness. His medical history included parkinson and mitral valve replacement.
Drug history 👉 Warfarin
Physical examination 👇
GCS = 14/15
BP = 130/86mmHg
PR = 88/min
RR = 10/min
T = 37.1°c
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1⃣ What is the differential diagnosis?
2⃣ Initial consideration in the management?
A 72-year old man has admitted to hospital with 10 days history of progressive confusion and unsteadiness. His medical history included parkinson and mitral valve replacement.
Drug history 👉 Warfarin
Physical examination 👇
GCS = 14/15
BP = 130/86mmHg
PR = 88/min
RR = 10/min
T = 37.1°c
➖➖➖➖➖➖➖➖➖➖➖
1⃣ What is the differential diagnosis?
2⃣ Initial consideration in the management?
👍17
➡️ Upcoming case 👇
A 26-year old boy with generalized skin rashes
A 26-year old boy with generalized skin rashes
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⬆️ Upcoming clinical case:
📌 A 3 year old girl with skin rashes shown in the pictures
📌 A 3 year old girl with skin rashes shown in the pictures
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Clinical Simulator 👩⚕🧑⚕
Photo
☝️☝️☝️☝️☝️☝️
✅ Hand-foot-mouth disease
📌 Causes
📌 Symptoms
📌 Prevention
📌 Treatment
✅ Hand-foot-mouth disease
📌 Causes
📌 Symptoms
📌 Prevention
📌 Treatment
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