09-05-2011, 01:07 PM
A 45-year-old woman presents to the emergency department because of the sudden onset of shortness of breath and chest tightness earlier this afternoon. She has been in excellent health and returned 2 days ago from a trip to Japan. She has not had a respiratory illness, but notes that she cannot seem to take a deep breath since this afternoon. On physical examination, her pulse rate is 116/min and respiration rate is 36/min. Cardiopulmonary examination is otherwise unmarkable, and a chest radiograph shows no infiltrates. Measurement of arterial blood gases on room air shows the following: pH 7.48, Pco 2 24 mm Hg, and Po 2 78 mm Hg; oxygen saturation is 96%
What is the most appropriate next step in this patient’s management?
(A) Pulmonary angiogram
(B) Compression ultrasonography of the lower extremities
© Therapy with diazepam
(D) Intravenous bolus of unfractionated heparin, followed by a continuous infusion
(E) Ventilation–perfusion lung scan
What is the most appropriate next step in this patient’s management?
(A) Pulmonary angiogram
(B) Compression ultrasonography of the lower extremities
© Therapy with diazepam
(D) Intravenous bolus of unfractionated heparin, followed by a continuous infusion
(E) Ventilation–perfusion lung scan