A 30s F, two-weeks post-partum, comes in with left pleuritic chest pain for a day. She has no PMH and reports no SOB. Vitals are HR 108, RR 16, BP 122/72, T 98.5, O2 sat 98. Exam is normal. The resident asks to send a d-dimer. What do you do?
Jacobi / Montefiore Emergency Medicine Residency
d- dimer is going to be elevated since she is post partum. EKG, trops, CXR. Will need to r/o PE in this patient.
S1Q3T3? …just kidding, we’ll kinda’. Take a peek for a right axis or TWI inf/anterior. She can have def have a PE with a normal ECG but looking to rule in. Ambulatory sat too, see if she drops. And yeah look for a blown RV (or a clot in transit scooting through the tricuspid🙈) or a DVT. So a dimer, maybe, but not yet…I’m pretty sure though that that dimer is def gonna be pos 2 wks post partum. Or this is all wrong and she’s got postpartum cardiomyopathy??
She is high risk for PE, post partum, tachy, pleurtic chest pain. She gets a CTPE regardless of EKG/sono/walking sat