Wednesday, November 02, 2005

Follow-up to drop in ETCO2

Good comments on this case. A drop in ETCO2 suggests a massive mismatch or loss of pulmonary vascular perfusion. Cardiac arrest would do that but I did not describe full arrest. DKeena mentioned esophageal intubation. It can be tricky especially in emergencies when a lot or air is bagged into the stomach and an initially +ETCO2 drops as the tube stays in the esophagus. Massive PE will cause a decrease in CO2-rich blood flow to the lungs. Since her ETT was properly placed and her EKG showed no ischemic changes (just the LAFB) and she is a sedentary (having back surgery, remmember?) I was concerned she had had a PE and requested and emergent CT. Check it out below:

Would you thrombolyze her?
What would you do next?

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