[oramar]

A patient was about to be discharged from non acute unit when he developed sever dyspnea, his pulse ox was in the 70s on R/A. O2 at 6L only got the patient up to 80s. A scan was positive for bilat PEs. A pulmonologist was consulted and wanted the patient to remain on non acute unit and recieve Lovenox. The attending overroad the order and insisted the patient be transfered to ICU and go on heparin drip. Is the treatment the pulmonologist ordered something new? I know I have not worked in acute for 6 years and things might have changed.

[suzanne4]

Lovenox is low-molecular weight heparin. Pts can actually be sent home on that, and give themselves SQ injections twice a day.

If a VQ scan, then the best result that would be given by radiologist is "high probability" -- they are never absolute with it. Would require a CT scan to confirm.

If the pulmonologist feels comfortable with leaving the patient there, then he is taking the responsibility for it. Not all patients with pulmonaru emboli need to go to the ICU. Are there issues that he was concerned with such as increased bleeding with full dose heparin? There are alot of other issues involved with this.

[sirI]

In addition to what suzanne4 stated, it depends upon the facility as well.

If the pulmonologist is "in house" the probability of leaving a patient in a non-actute area might be entertained. But, if a pulmonologist is not readily available, the decision to place in an acute-care area (ICU) would probably be made.

Also, consultation with a specialist is just that, consultation. Totally an expert opinion to take under advisement. Not necessarily the end-all be-all final decision.