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What Would I Do Next? | Jenna’s Story - Part Two

Mizuho Morrison, DO, Mike Weinstock, MD, and Jenna
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14:00
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No me gusta!

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Miz interviews a patient who nearly died from a massive PE. Mike and Miz discuss various factors in her case that make her story a great learning case.

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Robert M. -

Incredible story! Thanks for sharing.

Robert M. -

Surprised that D-dimer was not discussed as part of the initial work-up on her visit to Urgent Care. I know that "S1Q3T3" is the classic finding in someone with a PE, but it is my understanding that this only occurs in a small percentage of patients with a PE. Isn't it likely that both her ECG and her CXR would have come back normal. Therefore, with an initial presentation of mild calf pain, SOB, palpitations, and hypoxia the next step would have been labs that included D-dimer. This would have come back elevated prompting a referral to ED for further work-up.

Mike W., MD -

You are right - a PE was the dx to exclude - I do have mixed feelings on a d-dimer in the UC as the info would not be immediately available, but if the pt did have a PE, it would have been expected to b elevated. Caution with moderate to high risk 'rule outs' as many sources recommend proceeding directly to CTA!

Robert M. -

Thanks Mike! Really enjoying this podcast. Tons of great information.

Mary Ellen P., NP-C -

What a terrifying story for all parties involved! My thanks, as a listener, for sharing. It is easy to rush through patient encounters and this is a reminder to slow down and listen to the patient. It is so easy to do, but unfortunately easier to forget.

Mike W., MD -

Yes Mary, 'terrifying' would b an appropriate word! Thx for listening and thx for the comments!!
M

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Fibrillate into the Future! Full episode audio for MD edition 208:08 min - 98 MB - M4AHippo Urgent Care RAP - March 2018 Written Summary 487 KB - PDF

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