A 54-year-old man has a 3-hour history of chest pain and dyspnea. He is 1 week post colectomy of colon cancer. On examination, Temp 37.5C, BP 110/60 mmHg, HR 130/min, and RR 24/min, Oxygen saturation is 88% on room air and 94% on oxygen, 4L/min. Cardiac examination shows tachycardia. Breath sounds are normal. Serum creatinine concentration is 3 mg/dL. CT pulmonary angiography shows left sided pulmonary embolism. Which of the following is the most appropriate immediate treatment?
سؤال مجاني 6 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. IV unfractionated heparin
Confirmed PE in a patient with renal impairment (creatinine 3 mg/dL). LMWH (and fondaparinux) are cleared by the kidneys, so in renal impairment IV unfractionated heparin is preferred; it is also the agent of choice when rapid reversal may be needed (patient 1 week after colectomy). LMWH would be the usual choice with normal kidney function, which is the trap here. Subcutaneous UFH is not the standard immediate treatment route for acute PE (IV infusion with PTT monitoring).
ليش كل خيار صح أو غلط
-
A
ليش غلط
LMWH is excreted through the kidneys, so it must be used with caution in renal dysfunction.
✓ Step Up To Medicine 6th, 2024 (anticoagulation).pdf · p. 2 -
C
ليش صح
Patients with renal impairment (here creatinine 3 mg/dL) should be given UFH instead of LMWH.
✓ Pulmonology 🫁.pdf · p. 27 -
D
ليش غلط
UFH for acute PE is given as an IV infusion with frequent monitoring (inpatient), not subcutaneously.
✓ Step Up To Medicine 6th Edition 2024( PE).pdf · p. 11
- المصدر
- Pulmonology 🫁.pdf · p. 27
Step Up To Medicine 6th, 2024 (anticoagulation).pdf · p. 2
Step Up To Medicine 6th Edition 2024( PE).pdf · p. 11 - المحاضرة
- Venous Thromboembolism · Pulmonology · Module B
- ظهر في
- Respi bank