keysephFat emboli usually occur from long bone fractures, not hip fractures. Altered mental status is also a common symptom of fat emboli, which is not seen here. Petechiae can also be present, but are not necessary to make the diagnosis.
Regardless of this, this patient has a Wells score of at least 4 (HR >100, โฅ3 days of immobilization, hemoptysis). If you think PE is the most likely diagnosis (I personally did), then this patient has a Wells score of 7. For any patient with dyspnea and a Wells score of โฅ4, PE is likely, so you would heparinize and conduct a CTA or V/Q scan.+3
jlbaeThe femur is a long bone, but I agree with everything else you said+2
lubdubFeel free to judge, but I just realized in the last few weeks that when they say 'broke her hip' they're talking about the femur not the pelvis. +3
jmorga75I was going to make a comment about how Fat emboli don't usually present until a at least 24 hours after surgery, but on review it seems Uworld is inconsistent. Qid 3503/4561/12173/16061 - 24-72 hours after injury, Qid 4234 and Amboss- 12-24 hours after injury.
Furthermore, being pedantic has lost me more points that it has ever gotten me. +
submitted by โmedicalmike(82)
Normal V/Q scan rules out PE, regardless of pretest probability.
Low-risk V/Q scan in a low-risk patient rules out PE (unusual scenario for V/Q scan since D-dimer also appropriate)
High-risk V/Q scan in a high-risk patient confirms PE (this patient).
Any other combination warrants additional testing with CT angio.