Case 1

A 34 year old woman presents to the Emergency Department with several hours of shortness of breath and palpitations. She denies any cough, fevers or coryzal symptoms. She is noted to be dyspnoeic on exertion in the Emergency Department and complains of some chest discomfort on inspiration.

Vital signs at triage:

HR 105 & regular, RR 20, SpO2 95% in room air, BP 116/82, Temperature 37.3oC.

Her past medical history includes a first trimester miscarriage several years prior and she currently takes the combined oral contraceptive pill.

Question 1

What is the most likely diagnosis in this patient?

Question 2

What laboratory and/or radiological investigations would help you confirm this?

Question 3

What clinical decision rules can be used to determine this patient’s probability of this diagnosis?

Question 4

What is the Emergency management and disposition of this patient?