PE

Q. A patient who has recently undergone hip fracture repair develops the sudden

onset of shortness of breath. His pulse is 110 per minute. The chest is clear to auscultation.

Chest x-ray is normal, and the EKG shows sinus tachycardia. ABG shows

pH 7.48, pCO2 28, pO2 75. What is the next best step in management?

a. Heparin

b. V/Q scan

c. Spiral CT scan

d. D-dimers

e. Lower extremity Doppler

f. Angiography

Answer: A.

When the case so clearly suggests a pulmonary embolus with sudden onset

of shortness of breath and clear lungs in a patient with a risk factor, the first thing to

do after the chest x-ray and blood gas is to start heparin. Do not wait for the results of

V/Q scan or spiral CT to start heparin.