You are working at the triage desk in the ED when a young man on crutches approaches the desk. He appears moderately short of breath. He states he had a cast put on his left leg seven days ago after surgery for a ruptured Achilles tendon. This morning, while he was watching television, he suddenly became short of breath. He has a history of asthma, for which he takes Xopenex as needed, and is taking Tylenol with codeine for pain related to his surgery. The patient's lung sounds are clear and equal, SpO₂ is 90 percent on room air, heart rate is 100 and regular, respirations are 24 and slightly labored, blood pressure is 128/88, and the patient is afebrile. These findings are most consistent with: A) allergic reaction to codeine. B) asthma exacerbated by recent anesthesia. C) pneumonia secondary to recent anesthesia. D) pulmonary embolism associated with immobilization of the lower extremity.

Question

Quizplus · Accepted Answer

The patient's recent surgery and immobilization of the lower extremity put him at risk for developing a pulmonary embolism, which is a blood clot in the lungs. The sudden onset of shortness of breath and slightly labored breathing suggest that a pulmonary embolism may be the cause. The patient's clear lung sounds and lack of fever argue against pneumonia, and the fact that his symptoms began while he was at rest suggest that his asthma is less likely to be the primary cause. A codeine allergy would more likely cause a sudden onset of rash, itching, swelling, or hives, as well as difficulty breathing, which is not present here.

You Are Working at the Triage Desk in the ED