Pulmonary Embolism

HISTORY:

Sudden onset of ‍chest painshortness of breath for ‍ ‍hoursdays

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍shortness of breath

‍hemoptysis

‍leg pain

‍leg swelling, ‍rightleftsymmetrical

‍dizziness

‍syncope

‍anxiety

‍sweating

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Breasts: -R: ‍normal, -L: ‍normal

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Pulmonary embolism ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍troponin, ‍coagulation profile, ‍D-dimer

- Chest X-ray

- CT pulmonary angiogram

- V/Q scan

- ECG

- Echocardiogram

- Lower limb venous doppler ultrasound

- Cardiac monitoring

- ‍Anticoagulants

- ‍Thrombolytics if signs of massive PE

- Oxygen to maintain SpO2 > 92%

- Referral to pulmonologist

- Referral to hematologist

- Referral to internist

- Investigation of underlying cause (maligancy, thrombophilia)

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as chest pain, shortness of breath, or fainting

- Go to ER if severe chest pain, severe shortness of breath, or fainting occurs