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Senior Medicine and Surgery Prescribing Tutorial 9 Patient details Enid Robinson 67 years old, weight 75kg PC: Mrs Robinson is admitted with a 6 hour history of sudden onset shortness of breath, left sided pleuritic chest pain and haemoptysis. She was previously well and independent. PMH: Hypertension Medications: Amlodipine 10mg OD Allergies: None known Family History: Nil of note Social History: Non-smoker, 5 units alcohol / week Observations: HR 110, BP132/84, Sats 93% on air, RR 26, T: 37.7 On examination: HS I+II +0 Chest clear Abdo soft, non-tender, no masses / organomegaly Legs – no oedema / sign of DVT Investigations: ABG (air) pO2 7.5, pCO2 18.6, pH 7.38, HCO3 18.6 ECG Sinus tachycardia, normal axis, no other acute changes CXR – nil focal FBC / LFT Normal. INR 1.1 Na 136, K 4.6, Urea 6.5, Creatinine 93 Your registrar has reviewed the patient and thinks pulmonary embolism is the most likely diagnosis but it is midnight and the definitive radiological investigation to confirm the diagnosis is not available until the next morning. 1. How “likely” is PTE in this case? 2. What initial management measures, other than specific treatment for the suspected diagnosis are required? Complete an initial prescription chart for Mrs Robinson based on the information above The next morning a CTPA is performed which shows occlusive thrombus seen in left main pulmonary artery and segmental arteries. Lungs are clear otherwise, no sign of right heart strain. 3. Are any other investigations indicated? What should you consider now before any further prescription? Modify your prescription chart based on the confirmed diagnosis What