tailieunhanh - Case lâm sàng sản khoa - Case 4

Tham khảo tài liệu 'case lâm sàng sản khoa - case 4', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 22 A 19-ycar-old Gl PO woman at 20 weeks gestation complains of the acute onset of pleuritic chest pain and severe dyspnea. She denies a history of reactive airway disease or cough. On examination her temp is 98 F HR 120 bpm BP 130 70 and respiratory rate RR 40 min. The lung examination reveals clear lungs bilaterally. The heart examination shows tachycardia. The fetal heart tones are in the 140-150-bpm range. What test would most likely lead to the diagnosis What is your concern m CASE FILLS OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 22 Pulmonary Embolus in Pregnancy Suiiiiiicirv A 19-ycar-old i 1 PO woman at 20 weeks gestation complains of the acute onset of pleuritic chest pain and severe dyspnea. On examination her HR is 120 bpm and RR 40 min. The lung examination reveals clear lungs bilaterally. Test most likely to lead to the diagnosis Ventilation-perfusion scan. Your concern Pulmonary embolism. Analysis Considerations This 19-year-old woman at 20 weeks gestation complains of the acute onset of severe dyspnea and pleuritic chest pain. The physical examination confirms the respiratory distress due to the tachycardia and tachypnea. The lungs are clear on auscultation which rules out reactive airway disease or significant pneumonia. The patient also does not complain of cough or fever further making pneumonia unlikely. Clear lungs also speak against pulmonary edema. Thus the most likely diagnosis and concern is pulmonary embolism. Although many diagnostic tests should be considered in the initial evaluation of a patient with respiratory distress such as arterial blood gas chest radiograph electrocardiograph in this case the ventilation-perfusion scan would most likely lead to the diagnosis. If the V-Ọ scan confirms pulmonary embolism then the patient should receive anticoagulation to help stabilize the deep venous thrombosis and decrease the likelihood of further embolization. Pregnancy causes venous stasis due to the mechanical effect of the uterus on the .