Look For A Pulmonary Embolism

You have attended a patient who appears to be hyperventilating for no apparent reasons.

As you walk through the door, her husband tells you that she has been having intermittent periods of shortness of breath and looks terrified. As you walk through the door you can hear her clearly hyperventilating.

On Examination you find:

A 55 year old female who is mildly overweight. Alert. Skin pale, cool, diaphoretic. On Auscultation: chest clear. Good Air entry to bases. L =R. Inspiratory = Expiratory Phase. Speaking in single words only. Tachypnoeic at 36 resp per minute. Saturations: 84 on room air.

PMHx: High cholesterol.

Recent Hx: Flew long distance international flight yesterday.

Conclusion: most likely a pulmonary emobolism due to the obesity, poor cardiovascular healthy, and long haul flight with decreased movement for long periods.

Treatment options: high flow oxygen (although it probably wont help much) and urgent transport to a hospital that either 1. has cardiothoracic surgery capabilities or 2. heparin/thromalytic options.