ECG Case 4

Question 1

HPC: Mrs White is a 78 year old lady on the orthopaedic ward. She is 3 days post op after a left total hip replacement. The procedure was uncomplicated and she had been recovering well. Today she reports some non-specific chest discomfort with some associated shortness of breath. Wound looks clean with no leg swelling.

BG: HTN, ulcerative colitis, OA

OE:
Obs: RR 22, Sats 90% (OA), HR 78, BP 112/78, Temp 36.6

CVS: CRT <2, HS I+II+O, Pulse regular

Resp: Clear, Good AE

Answer 1

-

Question 2

This is her ECG. What are the abnormalities seen?

Answer 2

• right axis deviation
• right bundle branch block
• T wave inversion in leads III and V1-V4
• S1Q3T3 pattern (suggestive of cor pulmonale)

Question 3

what is the likely dx?

Answer 3

PE

Question 4

what scoring system would you use to estimate the probability of this likely dx? what is the score?

Answer 4

Wells score, 4.5

Question 5

What are the risk factors associated with this condition?

Answer 5

• immobility
• recent surgery
• fracture
• HTN
• UC

Question 6

How would you manage this patient?

Answer 6

• CT pulmonary angiogram (CTPA)
• O2
• manage with Rx dose LMWH
• thrombolysis if haemodynamically unstable