Tons of learning today from Gladys in report! Starting with a general approach to dyspnea then moving to SOB in post-op ortho patients and when to think about imaging for pulmonary embolism.
D-dimer pearl: A negative dimer has fantastic NEGATIVE predictive value, but a positive value must be used in clinical context and does not necessarily mean going to a CTA or VQ scan if you have other good reasons to explain the SOB.
We also talked about cardiac contusion as a possible cause of shortness of breath in a patient who was recently involved in a MVA.
Cardiac contusions can present in a multitude of ways ranging from sub-clinical arrhythmia to free wall rupture and sudden death.
Tamponade should be suspected in trauma patients with elevated neck veins, hypotension, distant heart sounds (Beck’s triad). FAST ultrasound in the ED can be helpful and surgery is the consultant of choice.
Heart failure symptoms due to transient myocardial dysfunction should be treated like a normal HF exacerbation with echocardiogram to assess for degree of myocardial damage and telemetry monitoring to assess for arrhythmia.
True ACS is a rare complication of cardiac contusion (troponin elevation from myocardial damage not related to ischemia is common however). Stenting vs. CABG is debated by cardiologists, but avoid thrombolytics!