The 28 yr Female, known case of SLE, was is remission due to pregnancy. She underwent cesarian, which uneventful. After 48 hr patient became tachypneic, tachycardia, diaphoretic, hypotensive. Oxygen saturation dropped to 85% on RA. How to approach and manage this patient. Was shifted to me 10 litre oxygen, and dopamine drip.
Once patient came to us our clinical diagnosis was moderate to massive Pulmonary embolism. We did ECHO and usg chest which confirmed our diagnosis OF DVT with PE. As patient underwent major surgery thrombolysis was out of question. PE thrombolectomy catheter is not available. We decided to give enoxaparin 0.1 mg /KG BD , NIV support and Noradrenaline. As patient was non acidotic and RV function was good she was more of case of moderate PE. We expected her to get better with regimen. She did bleed in her surgical site for which we had to open it and pack it. She recovered in 7 days. Later we had put her on warf.
2- moderate PE IN POST OP condition can be managed without thrombolysis with appropriate supportive care and LMWH or conventional heparinisation. They need very close monitoring and hemodynamic management.
