Question

A 27-year-old woman arrives in the emergency department 3 weeks after the vaginal delivery of her first child. She is transferred to the critical care unit after an acute onset of dyspnea and chest pain. Vital signs are blood pressure, 120/88 mm Hg; heart rate, 122 beats/min; and respiratory rate, 32 breaths/min. Arterial blood gases reveal a pH of 7.48, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of 55 mm Hg, and an arterial oxygen saturation of 89% on 100% oxygen by nonrebreathing mask. Jugular venous distention is evident, and cardiac auscultation reveals an accentuated P2 and an S3 and S4 of the right side. A ventilation/perfusion scan indicates high probability of a pulmonary embolism. What treatment is indicated at this time?

A. Intubation and mechanical ventilation
B. Heparin
C. Fibrinolytic agents
D. Pulmonary embolectomy

Answer 1

The indicated treatment for the woman with a high probability of pulmonary embolism is anticoagulant therapy with heparin, unless contraindications are present. Heparin helps to prevent further clotting and allows the patient's body to naturally resolve the existing pulmonary embolism.

Step-by-step explanation:

The treatment indicated for a 27-year-old woman with an acute onset of dyspnea and chest pain after vaginal delivery of her first child, whose vital signs and ventilation/perfusion scan suggest a high probability of pulmonary embolism (PE), is anticoagulant therapy with heparin. This treatment is essential to prevent further clot formation and to stop existing clots from getting larger. Heparin is usually administered intravenously in acute settings of PE and is the preferred initial treatment unless contraindicated.

While other options such as intubation and mechanical ventilation, fibrinolytic agents, and pulmonary embolectomy can be considered, they are not the first-line treatments in most cases of PE. However, intubation and mechanical ventilation may become necessary if there is evidence of respiratory failure. Fibrinolytic therapy and surgery are typically reserved for massive PE causing hemodynamic instability, which does not appear to be the case based on her blood pressure.