A 34 year old woman presents to Emergency Department with acute shortness of breath. This has begun suddenly some 8 hours ago.

She also complains of some mild pain around the right hand side of her chest which is worse on inspiration. She denies a cough, fever or collapse. She has no significant past medical history. She takes the combined oral contraceptive pill and no other medications. She has no known drug allergies. She smokes 10 a day and has done for the last 20 years, and takes occasional alcohol. Her mother is currently on treatment for her second deep vein thrombosis.

On Examination

  • Obs: HR 114, RR 18, SpO2 99%, BP 126/76, Temp 37.6

  • CVS: Heart sounds normal, pulses present in all limbs, nil swelling of legs identified.

  • Resp: Good air entry on the right, mildly reduced on the left. Otherwise normal breath sounds heard.

  • Abdominal: Unremarkable

  • Neurological: Unremarkable

  • ECG: Sinus Tachycardia

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. What are your differential diagnoses for this patient and why?

  2. What initial investigations would you perform and why?

  3. What risk stratification tools are available to you for this patient?

  4. Assuming the D-Dimer is 3.4 how would you manage this patient?

  5. What are the risk factors for the most likely diagnosis?

  6. What factors affect whether she can be managed in the community or not?

  7. If this patient was to deteriorate and her blood pressure was 70/40, how would you manage her?

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