Medicine
A 25-year-old woman non-smoker presents to Emergency Department with sudden onset of severe chest pain and…
A 25-year-old woman non-smoker presents to Emergency Department with sudden onset of severe chest pain and shortness of breath. Her past medical history is significant for caesarean section 4 days ago. Her examinations show a distressed woman with oxygen saturation 92% but otherwise unremarkable. Chest radiography is unremarkable. Which of the following is the most appropriate management?
Explanation
Core Concept: Pulmonary embolism (PE) is highly suspected in a postpartum or post-surgical patient presenting with sudden pleuritic chest pain, dyspnea, and hypoxia. Pregnancy and the postpartum period are hypercoagulable states.
Clinical Presentation:
- Sudden onset dyspnea, pleuritic chest pain, tachycardia, and hypoxemia.
- Risk factors: Recent surgery (C-section), immobility, pregnancy.
Diagnosis:
- First-line tool: Wells criteria for PE, D-dimer (if low probability), and CT pulmonary angiography (CTPA).
- Gold standard: CTPA or V/Q scan to definitively visualize the thrombus.
Management:
- Acute: In a patient with high clinical suspicion for PE, empiric therapeutic anticoagulation with Low Molecular Weight Heparin (LMWH) should be started immediately, even before imaging is completed, provided there are no contraindications.
- Long-term/Definitive: Continue anticoagulation for at least 3 to 6 months.