A 55-year-old patient on post-op day 5 from an extensive abdominal surgery suddenly develops dyspnea, pleuritic chest pain, and tachycardia. Which findings and actions are appropriate as the team works up suspected pulmonary embolism (PE)? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Options 2, 3, 4, and 5 are appropriate. Support oxygenation and monitoring, assess pretest probability, and obtain CT pulmonary angiography when suitable. If clinical probability is high and bleeding risk is acceptable, the team may begin anticoagulation promptly, especially when imaging will be delayed; recent surgery and other contraindications must be weighed. D-dimer is most useful to exclude PE in appropriately selected patients with low or intermediate pretest probability, while troponin and BNP may help risk stratification after PE is suspected or confirmed. Option 1 is incorrect because a V/Q scan is generally reserved for situations in which CT pulmonary angiography is unsuitable or unavailable rather than being automatically preferred after surgery.
The ABSOLUTE rule for suspected DVT/PE: never massage, never apply hot or cold, never elevate aggressively, never measure leg circumference if extremely tender. The job is to suspect, anticoagulate, and image. The "massage to break up the clot" trap is one of the most-tested patient-safety errors on NCLEX.
55-year-old, post-op day 5 from extensive abdominal surgery. Sudden dyspnea, pleuritic chest pain, tachycardia. SpO2 90% on RA. Right calf is swollen and tender. Suspected pulmonary embolism.
Pulmonary embolism (PE) — Acute occlusion of a pulmonary artery by thrombus; presents with dyspnea, pleuritic pain, tachycardia, and hypoxemia.
Wells criteria for PE — Clinical scoring tool to stratify pretest probability; informs whether to use D-dimer or proceed to CTPA.
Empiric anticoagulation — Heparin or LMWH given before imaging in high-probability or unstable PE patients to prevent extension/recurrence.