Thread by @IM_Crit_

ICU pictorials: A patient was admitted for "weakness". Unimpressive vitals / phys exam / labs. A few days later because of temp 101 F, a fever w/u was initiated. Due to "SOB", a CT chest angio was done:

👆Massive saddle PE extending in both sides w evidence of R heart strain

Echo findings:

There was a clot in transit in the RA / RV. If you notice, the saddle PE was visible at the PA bifurcation:

If you had to guess the combination of BP and O2 sat on room air, at the time of the CT, what would you choose?

Patient had BP 120/86 and O2 sat was 94% on room air

Take-home message:
A patient can have huge PE clot burden WITHOUT hypotension or hypoxemia. Ruling out PE on the basis of "normal O2 sat and BP" can have dire consequences...

Thanks for reading!

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@NephroP @MynephCC @khaycock2 @TaotePOCUS @cianmcdermott @nickmmark @cjosephy @pdsalinas @KalagaraHari @UAlberta_Sono @EMUGs_ @critconcepts @MegriMohammed @emily_fri @curromir @Wilkinsonjonny #MedStudentTwitter

I hope the requests for CT chest angio will not exponentially increase after this post...