Tachypnea in a Patient After Hip Repair Surgery

Vital Signs

• Temperature: 98.4 °F, axillary

• Blood Pressure: 110/78 mm of Hg

• Heart Rate: 160 beats per min, sinus tachycardia on telemetry monitor ( Fig. 19.1 )

  

• Respiratory Rate: 44 breaths per min

• Oxygen Saturation: 82% on room air

Focused Physical Examination

A quick exam showed a middle-aged man with moderate respiratory distress, who was tachypneic and sitting up in bed. His chest auscultation was not significant for wheezing or crackles, and his breath sounds were equal bilaterally. His heart sounds were difficult to comprehend because of severe tachycardia. He denied any chest pain or pain anywhere else in the body.

Interventions

The patient was supplied with supplementary oxygen through a nasal cannula. A stat troponin, lactate level, complete blood count (CBC), arterial blood gas, and portable chest X-ray were ordered. Cardiac monitor pads were attached to the patient’s chest. A 12-lead electrocardiogram (EKG) showed sinus tachycardia. Chest X-ray did not show any acute cardiopulmonary disease. Arterial blood gas showed a pH of 7.52, paO ₂ of 50, pCO ₂ of 30, and SPO ₂ of 84%. At this time it was determined that the most likely (EKG) differential diagnosis for this event was an acute pulmonary embolism (PE). The patient was prophylactically started on a therapeutic heparin drip and sent down to the radiology department for computed tomography (CT) of the chest for the evaluation of PE. CT scan showed a large saddle embolus with signs of right ventricular (RV) strain. The patient was transferred to the intensive care unit (ICU) directly from the radiology department to monitor his hemodynamic status closely.

Final Diagnosis

Acute submassive PE.

Alternative Diagnosis: Pulmonary fat embolism (can be primary diagnosis in a similar patient who did not get the fracture repaired); it can be differentiated from a PE on CT.