The Shocked Patient [Case #2]

“A 25 year old lady has returned from her holiday in Australia, she too has become short of breath. She also has noticed some pains in her calf and now she has a stabbing pain in the left of her chest, worse every time she breathes in. She also takes the OCP.”

On Examination

• She is tachycardic and and hypoxic on high flow oxygen.

• Her blood pressure is only 85/42 and she is looking tired.

• You strongly suspect a PE and are keen to confirm your diagnosis and continue her management.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

1. What are the indications for thrombolysis?

2. Which drug would you use (including the dose) to thrombolyse a massive PE?

3. What might you expect to see on a bedside echocardiogram?

4. If she were to arrest what modification(s) should you make to the standard ALS algorithm?

5. What are the components of the Wells Score for PE?

6. How does a PE cause shock?