An elderly c/o SOB for 2 days. Sat at ~ 80's at room air and increased to 93% at 4LPM. VS 200/100, HR 120 RR 26 afebrile. + Wheezing.
Image 1 - 12 L
Image 2 - Full disclosure on telemetry
Trop was negative, K and Ca was in the normal range, pro-BNP ~ 3000, D-dimer ~ 700. CT showed bilateral pulmonary embolism (PE).
Image 3 - Composite images of CXR, CTA of the chest and lead I/III
In the real world, the classic changes we expect to see are not there all the time but I think they are there somewhere. The 12L only captures the 10 sec event. During telemetry, the ECG showed dynamic QRST changes: S in I and Q in III and T wave inversion or S1Q3T3 pattern seen in patients with PE.
The patient was started on enoxaparin (bridge) and coumadin. Patient was discharged after a few days.