Pulmonary Embolism

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of sudden onset of ‍chest painshortness of breath

Symptoms include:

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath

‍hemoptysis

‍leg pain

‍leg swelling, ‍rightleftsymmetrical

‍dizziness

‍syncope

‍anxiety

‍sweating



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍obesity

‍smoking

‍prolonged immobility

‍recent trauma

no history of: ‍PE or DVT, ‍clotting disorders, ‍cancer, ‍heart disease, ‍pregnancy

no use of: ‍anticoagulants, ‍oral contraceptive, ‍hormone replacement therapy

no family history of: ‍clotting disorders





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Breasts: ‍normal, ‍mass, ‍axillary adenopathy

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Pulmonary embolism ‍likelysuspectedpossible

DDx: pulmonary embolism, musculoskeletal pain, right heart strain, chronic thromboembolic pulmonary hypertension, pneumonia, heart failure, acute coronary syndrome, pericarditis, tamponade, pulmonary hypertension, asthma exacerbation, COPD exacerbation, pleural effusion, pneumothorax, rib fracture, costochondritis, anxiety/panic disorder





PLAN:

Investigations:

- 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

Treatments:

- ‍Anticoagulants

- ‍Thrombolytics if signs of massive PE

- Oxygen to maintain SpO2 > 92%

Further care:

- 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

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