Question

A 24-year-old man who was in an automobile crash and required a chest tube for a pneumothorax has developed shortness of breath. After an evaluation, you diagnosed a PE and began standard therapy with IV heparin. The patient has been fully heparinized for 3 days and doing well, with a PTT consistently maintained at twice control level. Bowel function has returned to normal, and he has had no recurrent episodes of dyspnea, chest pain, or complications from the heparin treatment. A nurse reports an acute episode in which the patient was extremely short of breath. His BP was 90/60 mm Hg for several minutes, and he appeared ashen and cyanotic. The nurse ad- ministered nasal oxygen, "turned up" his IV fluids, and is now calling you. The patient's vital signs have returned to normal, and he is feeling better. On examination, you note a heart rate of 120 beatslmin, a respiratory rate of 28 breathslmin, and a normal blood pressure. The lungsare clear and heart sounds are normal. The abdomen is flat with no pain or tenderness, and the wound is healing normally.

Answer 1

The symptoms presented by the 24-year-old man after an automobile crash, and while on heparin therapy for PE, suggest a possible recurrent embolic event or complications from the existing PE, despite his PTT levels being managed properly. Immediate further diagnostic evaluation is required, as his symptoms, including an acute episode of shortness of breath and hypotension, are concerning.

Step-by-step explanation:

The sudden onset of shortness of breath and hypotension in a 24-year-old man currently on IV heparin therapy for a pulmonary embolism (PE) is concerning for another possible embolic event or complications from the existing PE. Even though the patient's PT (prothrombin time) has been PTT consistently maintained at therapeutic levels, it does not completely eliminate the risk of recurrent PE. The fact that the patient's vital signs normalized after the acute episode and there is no pain or tenderness in the abdomen or wound site does not rule out serious internal complications. Further diagnostic imaging and close monitoring are warranted to ensure the patient's safety. Given the acuity of his symptoms despite normalized vital signs, urgent reevaluation is critical to address potential complications such as recurrent PE or cardiac issues potentially associated with the PE.