1. Case Presentation
R1 이기만

2. 5003549 신 0 0 F/80 Chief Complaint : Dyspnea Duration : 내원 1시간 전
(식전 insulin 맞은 뒤 )

3. Past History :
DM/HTN/Hepatitis/Pul. Tbc(+/+/-/-)
Arthritis – po medi 중
Operation History : 2년전 shoulder Fx.로 op. 받음
Medication History
lantus 28u + humalog 10u premeal
tenormin 25mg, lipitor 10mg, atacand 16mg ,
dichlozid 25mg splendil ER 10mg, berasil 40mg #2 avandia 4mg, gasmotin, halcion 0.25mg, evista 60mg, cal-D-vita
Allergy History (-)

4. Review of System Fever/chill/sweating(-/-/+) Headache/dizziness(-/-)
Cough/sputum/dyspnea(-/-/+)
Chest pain/discomfort(-/-)
Nausea/vomiting(-/-)
Abdominal pain/discomfort(-/-)

5. Physical Examination Vital sign: 163/75mmHg/81회/30회/35.3도
General appearance
Acute ill-looking appearance
Skin
Sweating
Chest/lung
Symmetric expansion without retraction
Clear breathing sound
Abdomen : soft and flat,
Normoactive bowel sound

6. Initial Impression 1) R/O Hypoglycemia 2) R/O pulmonary embolism
3) R/O pneumothorax
4) DM
5) HTN

7. Initial Intervention
BST : 135mg/DL

8. Initial Lab Finding CBC 9310㎕/16.6g/gL/45.0%/311000/㎕ Electrolyte
143mmol/L/3.9mmol/L/107mmoL/22mmol/L
PT/aPTT sec/26.5sec
Glucose mg/dL
BUN/Cr mg/dL/1.1mg/dL
CK/CK-MB/TnT
32 IU/L /1.71ng/ml /<0.01ng.ml
ABGA
PH PCO2/Po /126.3mmHg
HC mmol/L TC mmol/L Saturation 99.7%
D-dimer 1253ng/ml

9. Chest PA

10. EKG

11. Further study (Echo)
- Borderline enlarged LA with normaml global LV systolic function (EF=71%)
- Normal RVP (=29.3mmHg)

12. CT pulmonary embolism

13. CT pulmonary embolism

14. Final Diagnosis
Pulmonary embolism

15. Progress HOD #2 - Heparinization (18ugtt) - dyspnea 호전 됨 (No more O2)
- CT Lower extremity angio : No DVT

17. Progress
HOD #6
- Abd. Sono : fatty liver
- 타병원 전원