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He was started on a heparin drip and CTA of the chest was ordered to rule out pulmonary embolism. The patient was upgraded to the ICU for closer monitoring. This is a case like many others posted (see list below) and the EKG from the patient’s original presentation can be quickly recognized as diagnostic for pulmonary embolism.
He was requiring supplemental oxygen and an initial bedside cardiac ultrasound was unremarkable. He was administered a therapeutic dose of low-molecular weight heparin and transferred to the ICU. Extensive clot burden in bilateral lower extremities was visualized on ultrasound. Cardiology was consulted.
Bedside cardiac ultrasound showed moderately decreased LV function. CT of the chest showed no pulmonary embolism but bibasilar infiltrates. CASE CONTINUED She was admitted to the ICU. She was intubated. LBBB, ventricular pacing, etc.)."
Once stabilized, intravascular ultrasound showed significant thrombus and plaque in the LAD. While preparing for transport to the cardiac ICU, the Impella device malfunctioned, and function could not be restored. This was treated with a drug-eluting stent, but TIMI 3 flow was not achieved.
in the ICU but survived with excellent function. Patients with pulmonary embolism or aortic dissection who have normal variant ST elevation are at high risk of being diagnosed with pericarditis when what they have is far more serious!! Beware a negative Bedside ultrasound. You diagnose pericarditis at your peril! Pericarditis?
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