Download Complete an initial prescription chart for Mrs Robinson

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
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