Short of Breath...

Case #1 - Answer Key

A 32-year-old African American female complains of right-sided chest pain, non-productive cough and SOB that began yesterday and has not resolved.  She states that the symptoms began when she was walking home after work.  She denies any dizziness, weakness or syncope.  She has no significant medical history, but she does admit to smoking half a pack per day and denies alcohol use.  Her only home medication is NuvaRing.  Her initial vital signs are BP 130/80, P 96, R 18, O2 98%.  Her skin is warm, normal color and dry.  She is alert and oriented and neurologically intact.

Develop a list of the top 5 differential diagnoses for this patient

The top 5 “killers” associated with chest pain are:

Acute coronary syndrome

Pulmonary embolism

Thoracic aortic dissection

Tension pneumothorax

Esophageal rupture

The clinical presentation, history of present illness, and physical exam findings favor the diagnosis of pulmonary embolism.

List the questions or assessment techniques you want to ask/check to help narrow the list of differential diagnoses

Navigate to the link below to access the PowerPoint slides

High Risk Chief Complaints of the Chest (click on the blue text)

Develop a treatment plan for this patient

Treatment for uncomplicated pulmonary embolism is centered on supportive care and transport to definitive care.