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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Tsung, Ann H. Williams, Justin B. Whitford, Allen C. |
| Description | Country affiliation: United States Author Affiliation: Tsung AH ( Department of Surgery, Division of Emergency Medicine, University of Texas Health Science Center, San Antonio, Texas, USA.) |
| Abstract | BACKGROUND: Pulmonary embolism (PE) is a life-threatening condition that is extremely uncommon in the healthy pediatric population. OBJECTIVE: Because pediatric PE is rarely on the Emergency Physician's differential diagnosis, with this case we hope to increase the clinical suspicion for PE in children who present to the Emergency Department (ED). CASE REPORT: This is a case of bilateral pulmonary embolism in a 16-year-old basketball player whose only risk factor is oral contraceptive medication. Initial vital signs demonstrated a temperature of 37.1°C (98.8°F), blood pressure 124/74 mm Hg, heart rate 74 beats/min, respiratory rate 16 breaths/min, and oxygen saturation 100% on room air. Subsequent vital signs, physical examination, chest radiograph, electrocardiogram, and laboratory assessments were all within normal limits. Using clinician gestalt in combination with the patient's Wells score of 0, a D-dimer was obtained and returned at 1916 ng/mL. The computed tomography scan with PE protocol detected a total of seven pulmonary emboli bilaterally. The patient was anticoagulated with Lovenox (Sanofi US, Bridgewater, NJ) in the ED and admitted to the pediatric intensive care unit. Complete thrombophilia work-up was negative. The patient was discharged with Lovenox and was transitioned to warfarin. CONCLUSIONS: Emergency Physicians may be inclined to discharge a pediatric patient at low pre-test probability for PE with outpatient follow-up if the work-up is non-contributory. But the current adult PE clinical criteria are not as sensitive or specific in the pediatric population. This case demonstrates that the clinician's gestalt should play a major role in combination with the Wells score and PERC (pulmonary embolism rule-out criteria) rule to exclude PE until clinical decision rules specific for the pediatric population are established. |
| File Format | HTM / HTML |
| ISSN | 07364679 |
| Issue Number | 5 |
| Volume Number | 44 |
| Journal | The Journal of Emergency Medicine |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2013-05-01 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Emergency medicine Athletes Chest Pain Etiology Dyspnea Pulmonary Embolism Diagnosis Adolescent Anticoagulants Therapeutic Use Contraceptives, Oral Emergency Service, Hospital Enoxaparin Female Fibrin Fibrinogen Degradation Products Analysis Humans Drug Therapy Tomography, X-ray Computed Case Reports Journal Article |
| Content Type | Text |
| Resource Type | Case study Article |
| Subject | Emergency Medicine |
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