Question regarding treatment

[zacarias, ASN, RN]

Hey all,

So this week one of my patients had a BKA but his pain thing was that he had big clots all over his body in each extremity. He was heparin gtt and then Lovenox treatment dose. Also a IVC filter placed a couple days ago. He had a TEE which revealed no vegetation.

Anyway, yesterday for me he was found to be 89% sats on 2L so I treated him with more O2 but also gave him Lasix and they ordered a portable Xray. He seemed to get better eventually but he only got back to 94% on 5L.

At night, the third year resident showed me the Xray and with some scattered opacity she thought it looked like pulmonary edema.

Today I didn't work but I looked up his X-ray results from the radiologist and they say bibasilar atelectasis (post-op I'm sure) and a pneumonia. Well today I talked to the nurse taking care of the pt and apparently he's not doing well at all. He's on a nonrebreather most of the time and he's majorly tachypneic. They're treating him like he has a PE. It seems quite possible given his clots.

My question is, there was no mention that they are treating his pneumonia which was there before the desatting episodes but could be contributing to his SOB. Any ideas why not?

Also the resident thought the X-ray as pulmonary edema (no crackles) but the X-ray report doesn't say anything about extra fluid. Are third years not adept at reading X-rays or do we just leave it to the radiologist?

Hopefully I find out more about the patient tomorrow, I really hate not being there LOL even though I know I need my days off too.

[Tweety, BSN, RN]

I don't think reading xrays is an exact science. Our radiologists are notorious for saying things like "could be this, looks like that, might possibly maybe be.........". Seems like though pulmonary edema and pneumonia should be distinguishable.

If they are treating him for the PE did they do a CT thorox or a vq scan to confirm this? Perhaps this is why they aren't treated the pneumonia. They ran another test. Surely though he's already on post-op prophylactic antiobics for his BKA?

[zacarias, ASN, RN]

I don't think reading xrays is an exact science. Our radiologists are notorious for saying things like "could be this, looks like that, might possibly maybe be.........". Seems like though pulmonary edema and pneumonia should be distinguishable.

If they are treating him for the PE did they do a CT thorox or a vq scan to confirm this? Perhaps this is why they aren't treated the pneumonia. They ran another test. Surely though he's already on post-op prophylactic antiobics for his BKA?

Thanks for the reply Tweety. It does seem like X-rays aren't exact. I guess they really have to look at the whole clinical picture. They couldn't do a VQ because he doesn't have IV access. He has a PICC so I don't know why they can't use that. Anyway, it's frustrating not being there.