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PBL CASE PRESENTATION

PBL CASE PRESENTATION. Presenting Complaint. 70yo female Presents to ED with sudden onset SOB, chest pain and haemoptysis. Unable to walk due to recent hip replacement surgery At ED, BP  145/90 RR  30 Afebrile. History. Past Medical History Hypertension for 10 years

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PBL CASE PRESENTATION

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  1. PBL CASE PRESENTATION

  2. Presenting Complaint • 70yo female • Presents to ED with sudden onset SOB, chest pain and haemoptysis. • Unable to walk due to recent hip replacement surgery • At ED, • BP  145/90 • RR  30 • Afebrile

  3. History • Past Medical History • Hypertension for 10 years • Appendectomy 30 years ago • Osteoporosis • Hip replacement surgery 3 weeks previously after FNOF • Family History • Mother died of unknown cancer aged 73 • Father died of heart issues (unknown) • Children well • Medications/Allergies • Tritace (ACE inhibitor) • Bisphosphonates • Calcium and Vitamin D supplements • No Known Allergies • Social History • Previously smoked from ages 18-62 (1 pack/day) • Social drinker (1 glass of wine/week) • Average diet • Nil exercise • Overweight • Lives with husband

  4. Risk Factors • Immobility – Yes, due to her recent hip replacement surgery • Clottingdisorders - Nil • Recentinjury – Yes, FNOF injury • Recentsurgery – Yes, as above • Pregnancy – Not currently • Pasthistory/Familyhistory – Nil • Overweight/Obese – Somewhat overweight • Smoking – Yes, previous smoking history • OCPuse – Nil • Cancers – Nil

  5. Immediate management • Was given high flow oxygen. • Started on LMWH due to history

  6. Examination • HR: 126 • BP: 145/90 • RR: 30 bpm • Afebrile • Auscultation – course crackles over R lower lobe. • JVP – 5cm • Cardiovascular exam normal

  7. Investigation • ECG –sinus tachycardia • Troponin – normal. • CXR – slight blunting of R costophrenic angle (NB: this usually occurs after some time). • D-Dimer – positive • V/Q scan – medium (chance of PE) • Spiral CT scan with IV contrast performed – showed medium sized pulmonary emboli in R lower inter lobular artery.

  8. NB: this scan would conclude high risk of PE.

  9. a clot in the anterior segmental artery in the left upper lung

  10. Diagnosis • A medium sized pulmonary embolism most likely from a DVT, brought on by her inactivity following her hip replacement. • Following her initial LMWH, she was started on oral warfarin.

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