Possible PE
Long term care patient arrived in ED w/acute respiratory failure. Initially he was diuresed and appeared to respond so documentation was geared toward acute heart failure but in the H&P the MD also states in the same paragraph "Other differential certainly could be a PE in a gentleman that is off of his Coumadin (due to intracranial hemorrhage), although he has improved w/diuresis". Doppler studies were done and negative for DVT (hx of DVT). Within 24 hours of admit the patient arrested w/PEA and recurrent V-fib and expired. In the d/c summary the physician documents a list of "final diagnoses" which does not include HF. Last paragraph of d/c summary states "wife initially consented to having a limited post mortem study done to evaluate for possible PE since this certainly was one thought for what was in essence persistent pulseless electrical activity w/recurrent v-fib." Wife changed her mind and autopsy was not performed.
Should the principle dx be CHF? Should the MD be queried for principle diagnosis?
Thanks!
Should the principle dx be CHF? Should the MD be queried for principle diagnosis?
Thanks!
Comments
probably need to know if the PE was thought to be POA or only the heart
failure. It would also be helpful if the heart failure was mentioned in
the DC Summary. Going by your example, it just seems to muddy!
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, March 24, 2011 8:49 AM
To: Smith, David
Subject: [cdi_talk] Possible PE