Sat27November0445PM 47

A 26-year-old man is admitted to the Emergency department with a one hour history of severe pleuritic chest pain. He has developed the symptoms following a long-haul flight.

His blood pressure is 95/45 mmHg, heart rate 125 beats per minute. On examination he is alert and orientated, sweating, respiratory rate 25 breaths/minute and peripheries are cool. Oxygen saturation is 93% breathing air.

Which of the following drugs is the single most appropriate initial treatment?

(Please select 1 option)

Warfarin 8 mg orally

Abciximab 18 mg IV

Aspirin 300 mg orally

Heparin 5000 IU IV Correct

Alteplase 50 mg IV

Explanation

Thrombolysis should not be used as first line treatment for non-massive PE.

Unfractionated heparin (UFH) should be given to patients with intermediate or high clinical probability before imaging.

Computerised pulmonary angiogram (CTPA) is the first line investigation in the diagnosis of suspected PE.

Low molecular heparin (LMWH) should be considered as preferable to UFH, having equal efficacy and safety being easier to use and monitor.

Oral anticoagulation should only be commenced once VTE has been reliably confirmed.

Answer Statistics

1

1%

2

1%

3

3%

4

42%

5

54%

Times answered: 302